Novel method for down-regulation of amyloid

ABSTRACT

Disclosed are novel methods for combating diseases characterized by deposition of amyloid. The methods generally rely on immunization against amyloidogenic proteins (proteins contributing to formation of amyloid) such as beta amyloid (Aβ). Immunization is preferably effected by administration of analogues of autologous amyloidogenic polypeptides, said analogues being capable of inducing antibody production against the autologous amyloidogenic polypeptides. Especially preferred as an immunogen is autologous Aβ which has been modified by introduction of one single or a few foreign, immunodominant and promiscuous T-cell epitopes while substantially preserving the majority of Aβ&#39;s B-cell epitopes. Also disclosed are nucleic acid vaccination against amyloidogenic polypeptides and vaccination using live vaccines as well as methods and means useful for the vaccination. Such methods and means include methods for identification of useful immunogenic analogues of the amyloidogenic proteins, methods for the preparation of analogues and pharmaceutical formulations, as well as nucleic acid fragments, vectors, transformed cells, polypeptides and pharmaceutical formulations.

FIELD OF THE INVENTION

The present invention relates to improvements in therapy and preventionof Alzheimer's disease (AD) and other diseases characterized bydeposition of amyloid, e.g. characterized by amyloid deposits in thecentral nervous system (CNS). More specifically, the present inventionprovides a method for down-regulating (undesired) deposits of amyloid byenabling the production of antibodies against the relevant protein orcomponents thereof in subjects suffering from or in danger of sufferingfrom diseases having a pathology involving amyloid deposition. Theinvention also provides for methods of producing polypeptides useful inthis method as well as for the modified polypeptides as such. Alsoencompassed by the present invention are nucleic acid fragments encodingthe modified polypeptides as well as vectors incorporating these nucleicacid fragments and host cells and cell lines transformed therewith. Theinvention also provides for a method for the identification of analoguesof the deposit polypeptides which are useful in the method of theinvention as well as for compositions comprising modified polypeptidesor comprising nucleic acids encoding modified polypeptides.

BACKGROUND OF THE INVENTION

Amyloidosis is the extracellular deposition of insoluble protein fibrilsleading to tissue damage and disease (Pepys, 1996; Tan et al., 1995;Kelly, 1996). The fibrils form when normally soluble proteins andpeptides self-associate in an abnormal manner (Kelly, 1997).

Amyloid is associated with serious diseases including systemicamyloidosis, AD, maturity onset diabetes, Parkinson's disease,Huntington's disease, fronto-temporal dementia and the prion-relatedtransmissible spongiform encephalopathies (kuru and Creutzfeldt-Jacobdisease in humans and scrapie and BSE in sheep and cattle, respectively)and the amyloid plaque formation in for instance Alzheimer's seems to beclosely associated with the progression of human disease. In animalmodels over-expression, or the expression of modified forms, of proteinsfound in deposits, like the β-amyloid protein, has been shown to inducevarious symptoms of disease, e.g. Alzheimer's-like symptoms. There is nospecific treatment for amyloid deposition and these diseases are usuallyfatal.

The subunits of amyloid fibrils may be wild-type, variant or truncatedproteins, and similar fibrils can be formed in vitro from oligopeptidesand denatured proteins (Bradbury et al., 1960; Filshie et al., 1964;Burke & Rougvie, 1972). The nature of the polypeptide component of thefibrils defines the character of the amyloidosis. Despite largedifferences in the size, native structure and function of amyloidproteins, all amyloid fibrils are of indeterminate length, unbranched,70 to 120 Å in diameter, and display characteristic staining with CongoRed (Pepys, 1996). They are characteristic of a cross-β structure(Pauling & Corey, 1951) in which the polypeptide chain is organized inβ-sheets. Although the amyloid proteins have very different precursorstructures, they can all undergo a structural conversion, perhaps alonga similar pathway, to a misfolded form that is the building block of theβ-sheet helix protofilament.

This distinctive fibre pattern led to the amyloidoses being called theβ-fibrilloses (Glenner, 1980a,b), and the fibril protein of AD was namedthe β-protein before its secondary structure was known (Glenner & Wong,1984). The characteristic cross-β diffraction pattern, together with thefibril appearance and tinctorial properties are now the accepteddiagnostic hallmarks of amyloid, and suggest that the fibrils, althoughformed from quite different protein precursors, share a degree ofstructural similarity and comprise a structural superfamily,irrespective of the nature of their precursor proteins (Sunde M, SerpellL C, Bartlam M, Fraser P E, Pepys M B, Blake C C F J Mol Biol 1997 Oct.31; 273(3):729-739).

One of the most widespread and well-known diseases where amyloiddeposits in the central nervous system are suggested to have a centralrole in the progression of the disease, is AD.

AD

Alzheimer's disease (AD) is an irreversible, progressive brain disorderthat occurs gradually and results in memory loss, behavioural andpersonality changes, and a decline in mental abilities. These losses arerelated to the death of brain cells and the breakdown of the connectionsbetween them. The course of this disease varies from person to person,as does the rate of decline. On average, AD patients live for 8 to 10years after they are diagnosed, though the disease can last for up to 20years.

AD advances by stages, from early, mild forgetfulness to a severe lossof mental function. This loss is known as dementia. In most people withAD, symptoms first appear after the age of 60, but earlier onsets arenot infrequent. The earliest symptoms often include loss of recentmemory, faulty judgment, and changes in personality. Often, people inthe initial stages of AD think less clearly and forget the names offamiliar people and common objects. Later in the disease, they mayforget how to do even simple tasks. Eventually, people with AD lose allreasoning ability and become dependent on other people for theireveryday care. Ultimately, the disease becomes so debilitating thatpatients are bedridden and likely to develop other illnesses andinfections. Most commonly, people with AD die from pneumonia.

Although the risk of developing AD increases with age, AD and dementiasymptoms are not a part of normal aging. AD and other dementingdisorders are caused by diseases that affect the brain. In normal aging,nerve cells in the brain are not lost in large numbers. In contrast, ADdisrupts three key processes: Nerve cell communication, metabolism, andrepair. This disruption ultimately causes many nerve cells to stopfunctioning, lose connections with other nerve cells, and die.

At first, AD destroys neurons in parts of the brain that control memory,especially in the hippocampus and related structures. As nerve cells inthe hippocampus stop functioning properly, short-term memory fails, andoften, a person's ability to do easy and familiar tasks begins todecline. AD also attacks the cerebral cortex, particularly the areasresponsible for language and reasoning. Eventually, many other areas ofthe brain are involved, all these brain regions atrophy (shrink), andthe AD patient becomes bedridden, incontinent, totally helpless, andunresponsive to the outside world (source: National Institute on AgingProgress Report on Alzheimer's Disease, 1999).

The Impact of AD

AD is the most common cause of dementia among people age 65 and older.It presents a major health problem because of its enormous impact onindividuals, families, the health care system, and society as a whole.Scientists estimate that up to 4 million people currently suffer fromthe disease, and the prevalence doubles every 5 years beyond age 65. Itis also estimated that approximately 360,000 new cases (incidence) willoccur each year, though this number will increase as the population ages(Brookmeyer et al., 1998).

AD puts a heavy economic burden on society. A recent study in the UnitedStates estimated that the annual cost of caring for one AD patient is$18,408 for a patient with mild AD, $30,096 for a patient with moderateAD, and $36,132 for a patient with severe AD. The annual national costof caring for AD patients in the US is estimated to be slightly over $50billion (Leon et al., 1998).

Approximately 4 million Americans are 85 or older, and in mostindustrialized countries, this age group is one of the fastest growingsegments of the population. It is estimated that this group will numbernearly 8.5 million by the year 2030 in the US; some experts who studypopulation trends suggest that the number could be even greater. As moreand more people live longer, the number of people affected by diseasesof aging, including AD, will continue to grow. For example, some studiesshow that nearly half of all people age 85 and older have some form ofdementia. (National Institute on Aging Progress Report on Alzheimer'sDisease, 1999)

The Main Characteristics of AD

Two abnormal structures in the brain are the hallmarks of AD: amyloidplaques and neurofibrillary tangles (NFT). Plaques are dense, largelyinsoluble deposits of protein and cellular material outside and aroundthe brain's neurons. Tangles are insoluble twisted fibres that build upinside neurons.

Two types of AD exist: familial AD (FAD), which follows a certainpattern of inheritance, and sporadic AD, where no obvious pattern ofinheritance is seen. Because of differences in the age at onset, AD isfurther described as early-onset (occurring in people younger than 65)or late-onset (occurring in those 65 and older). Early-onset AD is rare(about 10 percent of cases) and generally affects people aged 30 to 60.Some forms of early-onset AD are inherited and run in families.Early-onset AD also often progresses faster than the more common,late-onset form.

All FADs known so far have an early onset, and as many as 50 percent ofFAD cases are now known to be caused by defects in three genes locatedon three different chromosomes. These are mutations in the APP gene onchromosome 21; mutations in a gene on chromosome 14, called presenilin1; and mutations in a gene on chromosome 1, called presenilin 2. Thereis as yet no evidence, however, that any of these mutations play a majorrole in the more common, sporadic or non-familial form of late-onset AD.(National Institute on Aging Progress Report on Alzheimer's Disease,1999)

Amyloid Plaques

In AD, amyloid plaques develop first in areas of the brain used formemory and other cognitive functions. They consist of largely insolubledeposits of beta amyloid (hereinafter designated Aβ)—a protein fragmentof a larger protein called amyloid precursor protein (APP, the aminoacid sequence of which is set forth in SEQ ID NO: 2)—intermingled withportions of neurons and with non-nerve cells such as microglia andastrocytes. It is not known whether amyloid plaques themselvesconstitute the main cause of AD or whether they are a by-product of theAD process. Certainly, changes in the APP protein can cause AD, as shownin the inherited form of AD caused by mutations in the APP gene, and Aβplaque formation seems to be closely associated with the progression ofthe human disease (Lippa C. F. et al. 1998).

APP

APP is one of many proteins that are associated with cell membranes.After it is made, APP becomes embedded in the nerve cell's membrane,partly inside and partly outside the cell. Recent studies usingtransgenic mice demonstrate that APP appears to play an important rolein the growth and survival of neurons. For example, certain forms andamounts of APP may protect neurons against both short- and long-termdamage and may render damaged neurons better able to repair themselvesand help parts of neurons grow after brain injury.

While APP is embedded in the cell membrane, proteases act on particularsites in APP, cleaving it into protein fragments. One protease helpscleave APP to form Aβ, and another protease cleaves. APP in the middleof the amyloid fragment so that Aβ cannot be formed. The Aβ formed is oftwo different lengths, a shorter 40 (or 41) amino acids Aβ that isrelatively soluble and aggregates slowly, and a slightly longer, 42amino acids “sticky” Aβ that rapidly forms insoluble clumps. While Aβ isbeing formed, it is not yet known exactly how it moves through or aroundnerve cells. In the final stages of this process, the “sticky” Aβaggregates into long filaments outside the cell and, along withfragments of dead and dying neurons and the microglia and astrocytes,forms the plaques that are characteristic of AD in brain tissue.

Some evidence exists that the mutations in APP render more likely thatAβ will be snipped out of the APP precursor, thus causing either moretotal Aβ or relatively more of the “sticky” form to be made. It alsoappears that mutations in the presenilin genes may contribute to thedegeneration of neurons in at least two ways: By modifying Aβ productionor by triggering the death of cells more directly. Other researcherssuggest that mutated presenilins 1 and 2 may be involved in acceleratingthe pace of apoptosis.

It is to be expected that as the disease progresses, more and moreplaques will be formed, filling more and more of the brain. Studiessuggest that it may be that the Aβ is aggregating and disaggregating atthe same time, in a sort of dynamic equilibrium. This raises the hopethat it may be possible to break down the plaques even after they haveformed. (National Institute on Aging Progress Report on Alzheimer'sDisease, 1999).

It is believed that Aβ is toxic to neurons. In tissue culture studies,researchers observed an increase in death of hippocampal neurons cellsengineered to over-express mutated forms of human APP compared toneurons over-expressing the normal human APP (Luo et al., 1999).

Furthermore, overexpression or the expression of modified forms of theAβ protein has in animal models been demonstrated to induceAlzheimer-like symptoms, (Hsiao K. et al., 1998)

Given that increased Aβ generation, its aggregation into plaques, andthe resulting neurotoxicity may lead to AD, it is of therapeuticinterest to investigate conditions under which Aβ aggregation intoplaques might be slowed down or even blocked.

Presenilins

Mutations in presenilin-1 (S-180) account for almost 50% of all cases ofearly-onset familial AD (FAD). Around 30 mutations have been identifiedthat give rise to AD. The onset of AD varies with the mutations.Mutations in presenilin-2 account for a much smaller part of the casesof FAD, but is still a significant factor. It is not known whetherpresenilins are involved in sporadic non-familial AD. The function ofthe presenilins is not known, but they appear to be involved in theprocessing of APP to give Aβ-42 (the longer stickier form of thepeptide, SEQ ID NO: 2, residues 673-714), since AD patients withpresenilin mutations have increased levels of this peptide. It isunclear whether the presenilins also have a role in causing thegeneration of NFT's. Some suggest that presenilins could also have amore direct role in the degeneration of neurons and neuron death.Presenilin-1 is located at chromosome 14 while presenilin-2 is linked tochromosome 1. If a person harbours a mutated version of just one ofthese genes he or she is almost certain to develop early onset AD.

There is some uncertainty to whether presenilin-1 is identical to thehypothetical gamma-secretase involved in the processing of APP (Naruseet al., 1998).

Apolipoprotein E

Apolipoprotein E is usually associated with cholesterol, but is alsofound in plaques and tangles of AD brains. While alleles 1-3 do not seemto be involved in AD there is a significant correlation between thepresence of the APOE-e4 allele and development of late AD (Strittmatteret al., 1993). It is, however, a risk factor and not a direct cause asis the case for the presenilin and APP mutations and it is not limitedto familial AD.

The ways in which the ApoE e4 protein increases the likelihood ofdeveloping AD are not known with certainty, but one possible theory isthat it facilitates Aβ buildup and this contributes to lowering the ageof onset of AD, or the presence or absence of particular APOE allelesmay affect the way neurons respond to injury (Buttini et al., 1999).

Also Apo A1 has been shown to be amyloigenic. Intact apo A1 can itselfform amyloid-like fibrils in vitro that are Congo red positive (Am JPathol 147 (2): 238-244 (August 1995), Wisniewski T, Golabek A A, KidaE, Wisniewski K E, Frangione B).

There seem to be some contradictory results indicating that there is apositive effect of the APOE-e4 allele in decreasing symptoms of mentalloss, compared to other alleles (Stern, Brandt, 1997, Annals ofNeurology 41).

Neurofibrillary Tangles

This second hallmark of AD consists of abnormal collections of twistedthreads found inside nerve cells. The chief component of tangles is oneform of a protein called tau (t). In the central nervous system, tauproteins are best known for their ability to bind and help stabilizemicrotubules, which are one constituent of the cell's internal supportstructure, or skeleton. However, in AD tau is changed chemically, andthis altered tau can no longer stabilize the microtubules, causing themto fall disintegrate. This collapse of the transport system may at firstresult in malfunctions in communication between nerve cells and maylater lead to neuronal death.

In AD, chemically altered tau twists into paired helical filaments—twothreads of tau that are wound around each other. These filaments are themajor substance found in neurofibrillary tangles. In one recent study,researchers found neurofibrillary changes in fewer than 6 percent of theneurons in a particular part of the hippocampus in healthy brains, inmore than 43 percent of these neurons in people who died with mild AD,and in 71 percent of these neurons in people who died with severe AD.When the loss of neurons was studied, a similar progression was found.Evidence of this type supports the idea that the formation of tanglesand the loss of neurons progress together over the course of AD.(National Institute on Aging Progress Report on Alzheimer's Disease,1999).

Tauopathies and Tangles

Several neurodegenerative diseases, other than AD, are characterized bythe aggregation of tau into insoluble filaments in neurons and glia,leading to dysfunction and death. Very recently, several groups ofresearchers, who were studying families with a variety of hereditarydementias other than AD, found the first mutations in the tau gene onchromosome 17 (Clark et al., 1998; Hutton et al., 1998; Poorkaj et al.,1998; Spillantini et al., 1998). In these families, mutations in the taugene cause neuronal cell death and dementia. These disorders which sharesome characteristics with AD but differ in several important respects,are collectively called “fronto temporal dementia and parkinsonismlinked to chromosome 17” (FTDP-17). They are diseases such asParkinson's disease, some forms of amyotrophic lateral sclerosis (ALS),corticobasal degeneration, progressive supranuclear palsy, and Pick'sdisease, and are all characterized by abnormal aggregation of tauprotein.

Other AD-Like Neurological Diseases.

There are important parallels between AD and other neurologicaldiseases, including prion diseases (such as kuru, Creutzfeld-Jacobdisease and bovine spongiform encephalitis), Parkinson's disease,Huntington's disease, and fronto-temporal dementia. All involve depositsof abnormal proteins in the brain. AD and prion diseases cause dementiaand death, and both are associated with the formation of insolubleamyloid fibrils, but from membrane proteins that are different from eachother.

Scientists studying Parkinson's disease, the second most commonneurodegenerative disorder after AD, discovered the first gene linked tothe disease. This gene codes for a protein called synuclein, which,intriguingly, is also found in the amyloid plaques of AD patients'brains (Lavedan C, 1998, Genome Res. 8(9): 871-80). Investigators havealso discovered that genetic defects in Huntington's disease, anotherprogressive neurodegenerative disorder that causes dementia, cause theHuntington protein to form into insoluble fibrils very similar to the Aβfibrils of AD and the protein fibrils of prion disease, (Scherzinger E,et al., 1999, PNAS U.S.A. 96(8): 4604-9).

Scientists have also discovered a novel gene, which when mutated, isresponsible for familial British dementia (FBD), a rare inheriteddisease that causes severe movement disorders and progressive dementiasimilar to that seen in AD. In a biochemical analysis of the amyloidfibrils found in the FBD plaques, a unique peptide named ABri was found(Vidal et al., 1999). A mutation at a particular point along this generesults in the production of a longer-than-normal Bri protein. The ABripeptide, which is snipped from the mutated end of the Bri protein isdeposited as amyloid fibrils. These plaques are thought to lead to theneuronal dysfunction and dementia that characterizes FBD.

Immunization with Aβ

The immune system will normally take part in the clearing of foreignprotein and proteinaceous particles in the organism but the depositsassociated with the above-mentioned diseases consist mainly ofself-proteins, thereby rendering the role of the immune system in thecontrol of these diseases less obvious. Further, the deposits arelocated in a compartment (the CNS) normally separated from the immunesystem, both facts suggesting that any vaccine or immunotherapeuticalapproach would be unsuccessful.

Nevertheless, scientists have recently attempted immunizing mice with avaccine composed of heterologous human Aβ and a substance known toexcite the immune system (Schenk et al., 1999 and WO 99/27944). Thevaccine was tested in a partial transgenic mouse model of AD with ahuman mutated gene for APP inserted into the DNA of the mouse. The miceproduced the modified APP protein and developed amyloid plaques as theygrew older. This mouse model was used to test whether vaccinationagainst the modified transgenic human APP had an effect on plaquebuild-up. In a first experiment, one group of transgenic mice was givenmonthly injections of the vaccine starting at 6 weeks of age and endingat 11 months. A second group of transgenic mice received no injectionsand served as a control group. By 13 months of age, the mice in thecontrol group had plaques covering 2 to 6 percent of their brains. Incontrast, the immunized mice had virtually no plaques.

In a second experiment, the researchers began the injections at 11months, when some plaques had already developed. Over a 7-month period,the control transgenic mice had a 17-fold increase in the amount ofplaque in their brains, whereas those who received the vaccine had a99-percent decrease compared to the 18-month-old control transgenicmice. In some mice, some of the pre-existing plaque deposits appeared tohave been removed by the treatment. It was also found that otherplaque-associated damage, such as inflammation and abnormal nerve cellprocesses, lessened as a result of the immunization.

The above is thus a preliminary study in mice and for example,scientists need to find out whether vaccinated mice remain healthy inother respects and whether memory of those vaccinated remains normal.Furthermore, because the mouse model is not a complete representation ofAD (the animals do not develop neurofibrillary tangles nor do many oftheir neurons die), additional studies will be necessary to determinewhether humans have a similar or different reaction from mice. Anotherissue to consider is that the method may perhaps “cure” amyloiddeposition but fail to stop development of dementia.

Technical issues present major challenges as well. For example it isunlikely that it is even possible, using this technology, to create avaccine which enables humans to raise antibodies against their ownproteins. So numerous issues of safety and effectiveness will need to beresolved before any tests in humans can be considered.

The work by Schenk et al. thus shows that if it was possible to generatea strong immune response towards self-proteins in proteinaceous depositsin the central nervous system such as the plaques formed in AD, it ispossible to both prevent the formation of the deposits and possibly alsoclear already formed plaques.

OBJECT OF THE INVENTION

The object of the present invention is to provide novel therapiesagainst conditions characterized by deposition of amyloid, such as AD. Afurther object is to develop an autovaccine against amyloid, in order toobtain a novel treatment for AD and for other pathological disordersinvolving amyloid deposition.

SUMMARY OF THE INVENTION

Described herein is the use of an autovaccination technology forgenerating strong immune responses against otherwise non-immunogenicself-proteins included in pathology-related amyloid deposits. Thereby, astrong immune response is generated against either the amyloid, againstone or more of the components included in the deposits, or against oneor more of the proteins responsible for amyloid formation. Described isalso the preparation of such vaccines for the prevention, possible cureor alleviation of the symptoms of such diseases associated with amyloiddeposits.

Thus, in its broadest and most general scope, the present inventionrelates to a method for in vivo down-regulation of amyloid in an animal,including a human being, the method comprising effecting presentation tothe animal's immune system of an immunologically effective amount of

-   -   at least one amyloidogenic polypeptide or subsequence thereof        which has been formulated so that immunization of the animal        with the amyloidogenic polypeptide or subsequence thereof        induces production of antibodies against the amyloidogenic        polypeptide, and/or    -   at least one amyloid analogue wherein is introduced a        modification in the amyloidogenic polypeptide which has as a        result that immunization of the animal with the analogue induces        production of antibodies against the amyloidogenic polypeptide.

Hence, encompassed by the present invention is the use of 1) naturallyoccurring antigens and fragments thereof formulated so as to trigger animmune response as well as of 2) analogues of such naturally occurringantigens, the analogues being capable of inducing cross-reactive immuneresponses.

The invention also relates to analogues of the amyloidogenicpolypeptides as well as to nucleic acid fragments encoding a subset ofthese. Also immunogenic compositions comprising the analogues or thenucleic acid fragments are part of the invention.

The invention also relates to a method of identifying immunogenicallyeffective analogues of amyloidogenic polypeptides as well as a methodfor preparing a composition comprising the analogues.

LEGEND TO THE FIGURE

FIG. 1: Schematic depiction of Autovac variants derived from the amyloidprecursor protein with the purpose of generating antibody responsesagainst the Aβ protein Aβ-43 (or C-100). The APP is shown schematicallyat the top of the figure and the remaining schematic constructs showthat the model epitopes P2 and P30 are substituted or inserted intovarious truncations of APP. In the figure, the black pattern indicatesthe APP signal sequence, two-way cross-hatching is the extracellularpart of APP, dark vertical hatching is the transmembrane domain of APP,light vertical hatching is the intracellular domain of APP, coarsecross-hatching indicates the P30 epitope, and fine cross-hatchingindicates the P2 epitope. The full line box indicates Aβ-42/43 and thefull-line box and the dotted line box together indicate C-100. “Abeta”denotes Aβ.

DETAILED DISCLOSURE OF THE INVENTION Definitions

In the following a number of terms used in the present specification andclaims will be defined and explained in detail in order to clarify themetes and bounds of the invention.

The terms “amyloid” and “amyloid protein” which are used interchangeablyherein denote a class of proteinaceous unbranched fibrils ofindeterminate length. Amyloid fibrils display characteristic stainingwith Congo Red and share a cross-β structure in which the polypeptidechain is organized in β-sheets. Amyloid is generally derived fromamyloidogenic proteins which have very different precursor structuresbut which can all undergo a structural conversion to a misfolded formthat is the building block of the β-sheet helix protofilament. Normally,the diameter of amyloid fibrils varies between about 70 to about 120 Å.

The term “amyloidogenic protein” is intended to denote a polypeptidewhich is involved in the formation of amyloid deposits, either by beingpart of the deposits as such or by being part of the biosyntheticpathway leading to the formation of the deposits. Hence, examples ofamyloidogenic proteins are APP and Aβ, but also proteins involved in themetabolism of these may be amyloidogenic proteins. A number ofamyloidogenic polypeptides are discussed in detail herein.

An “amyloid polypeptide” is herein intended to denote polypeptidescomprising the amino acid sequence of the above-discussed amyloidogenicproteins derived from humans or other mammals (or truncates thereofsharing a substantial amount of B-cell epitopes with an intactamyloidogenic protein)—an amyloidogenic polypeptide can therefore e.g.comprise substantial parts of a precursor for the amyloidogenicpolypeptide (in the case of Aβ, one possible amyloid polypeptide couldbe APP derived). Also unglycosylated forms of amyloidogenic polypeptideswhich are prepared in prokaryotic system are included within theboundaries of the term as are forms having varying glycosylationpatterns due to the use of e.g. yeasts or other non-mammalian eukaryoticexpression systems. It should, however, be noted that when using theterm “an amyloidogenic polypeptide” it is intended that the polypeptidein question is normally non-immunogenic when presented to the animal tobe treated. In other words, the amyloidogenic polypeptide is aself-protein or is an analogue of such a self-protein which will notnormally give rise to an immune response against the amyloidogenic ofthe animal in question.

An “analogue of an amyloidogenic polypeptide” is an amyloidogenicpolypeptide, which has been subjected to changes in its primarystructure. Such a change can e.g. be in the form of fusion of an amyloidpolypeptide to a suitable fusion partner (i.e. a change in primarystructure exclusively involving C- and/or N-terminal additions of aminoacid residues) and/or it can be in the form of insertions and/ordeletions and/or substitutions in the amyloidogenic polypeptide's aminoacid sequence. Also encompassed by the term are derivatizedamyloidogenic molecules, cf. the discussion below of modifications ofamyloidogenic polypeptides. In case the amyloidogenic polypeptide is anamyloid or a precursor therefore, the analogue may be constructed so asto be less able or even unable to elicit antibodies against the normalprecursor protein(s) of the amyloid, thereby avoiding undesiredinterference with the (physiologically normal) non-aggregated form ofthe polypeptide being a precursor of the amyloid protein.

It should be noted that the use as a vaccine in a human of axeno-analogue (e.g. a canine or porcine analogue) of a humanamyloidogenic polypeptide can be imagined to produce the desiredimmunity against the amyloidogenic polypeptide. Such use of anxeno-analogue for immunization is also considered part of the invention.

The term “polypeptide” is in the present context intended to mean bothshort peptides of from 2 to 10 amino acid residues, oligopeptides offrom 11 to 100 amino acid residues, and polypeptides of more than 100amino acid residues. Furthermore, the term is also intended to includeproteins, i.e. functional biomolecules comprising at least onepolypeptide; when comprising at least two polypeptides, these may formcomplexes, be covalently linked, or may be non-covalently linked. Thepolypeptide(s) in a protein can be glycosylated and/or lipidated and/orcomprise prosthetic groups.

The terms “T-lymphocyte” and “T-cell” will be used interchangeably forlymphocytes of thymic origin which are responsible for various cellmediated immune responses as well as for helper activity in the humoralimmune response. Likewise, the terms “B-lymphocyte” and “B-cell” will beused interchangeably for antibody-producing lymphocytes.

The term “subsequence” means any consecutive stretch of at least 3 aminoacids or, when relevant, of at least 3 nucleotides, derived directlyfrom a naturally occurring amyloid amino acid sequence or nucleic acidsequence, respectively.

The term “animal” is in the present context in general intended todenote an animal species (preferably mammalian), such as Homo sapiens,Canis domesticus, etc. and not just one single animal. However, the termalso denotes a population of such an animal species, since it isimportant that the individuals immunized according to the method of theinvention all harbour substantially the same amyloidogenic polypeptideallowing for immunization of the animals with the same immunogen(s). If,for instance, genetic variants of the amyloidogenic polypeptide existsin different human population it may be necessary to use differentimmunogens in these different populations in order to be able to breakthe autotolerance towards the amyloidogenic polypeptide in eachpopulation in an optimum fashion. It will be clear to the skilled personthat an animal in the present context is a living being which has animmune system. It is preferred that the animal is a vertebrate, such asa mammal.

By the term “in vivo down-regulation of amyloid” is herein meantreduction in the living organism of the total amount of depositedamyloid of the relevant type. The down-regulation can be obtained bymeans of several mechanisms: Of these, simple interference with amyloidby antibody binding so as to prevent misaggregation is the most simple.However, it is also within the scope of the present invention that theantibody binding results in removal of amyloid by scavenger cells (suchas macrophages and other phagocytic cells) and that the antibodiesinterfer with other amyloidogenic polypeptides which lead to amyloidformation.

The expression “effecting presentation . . . to the immune system” isintended to denote that the animal's immune system is subjected to animmunogenic challenge in a controlled manner. As will appear from thedisclosure below, such challenge of the immune system can be effected ina number of ways of which the most important are vaccination withpolypeptide containing “pharmaccines” (i.e. a vaccine which isadministered to treat or ameliorate ongoing disease) or nucleic acid“pharmaccine” vaccination. The important result to achieve is thatimmune competent cells in the animal are confronted with the antigen inan immunologically effective manner, whereas the precise mode ofachieving this result is of less importance to the inventive ideaunderlying the present invention.

The term “immunogenically effective amount” has its usual meaning in theart, i.e. an amount of an immunogen, which is capable of inducing animmune response that significantly engages pathogenic agents sharingimmunological features with the immunogen.

When using the expression that the amyloidogenic polypeptide has been“modified” is herein meant a chemical modification of the polypeptide,which constitutes the backbone of the amyloidogenic polypeptide. Such amodification can e.g. be derivatization (e.g. alkylation) of certainamino acid residues in the sequence of the amyloidogenic polypeptide,but as will be appreciated from the disclosure below, the preferredmodifications comprise changes of the primary structure of the aminoacid sequence.

When discussing “autotolerance towards an amyloidogenic polypeptide” itis understood that since the amyloidogenic polypeptide is a self-proteinin the population to be vaccinated, normal individuals in the populationdo not mount an immune response against the amyloidogenic polypeptide;it cannot be excluded, though, that occasional individuals in an animalpopulation might be able to produce antibodies against nativeamyloidogenic polypeptide, e.g. as part of an autoimmune disorder. Atany rate, an animal will normally only be autotolerant towards its ownamyloidogenic polypeptide, but it cannot be excluded that analoguesderived from other animal species or from a population having adifferent phenotype would also be tolerated by said animal.

A “foreign T-cell epitope” (or: “foreign T-lymphocyte epitope”) is apeptide which is able to bind to an MHC molecule and which stimulatesT-cells in an animal species. Preferred foreign T-cell epitopes in theinvention are “promiscuous” epitopes, i.e. epitopes which bind to asubstantial fraction of a particular class of MHC molecules in an animalspecies or population. Only a very limited number of such promiscuousT-cell epitopes are known, and they will be discussed in detail below.Promiscuous T-cell epitopes are also denoted “universal” T-cellepitopes. It should be noted that in order for the immunogens which areused according to the present invention to be effective in as large afraction of an animal population as possible, it may be necessary to 1)insert several foreign T-cell epitopes in the same analogue or 2)prepare several analogues wherein each analogue has a differentpromiscuous epitope inserted. It should be noted also that the conceptof foreign T-cell epitopes also encompasses use of cryptic T-cellepitopes, i.e. epitopes which are derived from a self-protein and whichonly exerts immunogenic behaviour when existing in isolated form withoutbeing part of the self-protein in question.

A “foreign T helper lymphocyte epitope” (a foreign T_(H) epitope) is aforeign T cell epitope, which binds an MHC Class II molecule and can bepresented on the surface of an antigen presenting cell (APC) bound tothe MHC Class II molecule.

A “functional part” of a (bio)molecule is in the present contextintended to mean the part of the molecule which is responsible for atleast one of the biochemical or physiological effects exerted by themolecule. It is well-known in the art that many enzymes and othereffector molecules have an active site which is responsible for theeffects exerted by the molecule in question. Other parts of the moleculemay serve a stabilizing or solubility enhancing purpose and cantherefore be left out if these purposes are not of relevance in thecontext of a certain embodiment of the present invention. For instanceit is possible to use certain cytokines ash a modifying moiety in anamyloidogenic polypeptide (cf. the detailed discussion below), and insuch a case, the issue of stability may be irrelevant since the couplingto the amyloidogenic polypeptide may provide the stability necessary.

The term “adjuvant” has its usual meaning in the art of vaccinetechnology, i.e. a substance or a composition of matter which is 1) notin itself capable of mounting a specific immune response against theimmunogen of the vaccine, but which is 2) nevertheless capable ofenhancing the immune response against the immunogen. Or, in other words,vaccination with the adjuvant alone does not provide an immune responseagainst the immunogen, vaccination with the immunogen may or may notgive rise to an immune response against the immunogen, but the combinedvaccination with immunogen and adjuvant induces an immune responseagainst the immunogen which is stronger than that induced by theimmunogen alone.

“Targeting” of a molecule is in the present context intended to denotethe situation where a molecule upon introduction in the animal willappear preferentially in certain tissue(s) or will be preferentiallyassociated with certain cells or cell types. The effect can beaccomplished in a number of ways including formulation of the moleculein composition facilitating targeting or by introduction in the moleculeof groups, which facilitate targeting. These issues will be discussed indetail below.

“Stimulation of the immune system” means that a substance or compositionof matter exhibits a general, non-specific immunostimulatory effect. Anumber of adjuvants and putative adjuvants (such as certain cytokines)share the ability to stimulate the immune system. The result of using animmunostimulating agent is an increased “alertness” of the immune systemmeaning that simultaneous or subsequent immunization with an immunogeninduces a significantly more effective immune response compared toisolated use of the immunogen

Preferred Embodiments of Amyloid Down-Regulation

It is preferred that the amyloidogenic polypeptide used as an immunogenin the method of the invention is a modified molecule wherein at leastone change is present in the amino acid sequence of the amyloidogenicpolypeptide, since the chances of obtaining the all-important breakingof autotolerance towards the amyloidogenic polypeptide is greatlyfacilitated that way—this is e.g. evident from the results presented inExample 2 herein, where immunization with wild-type Aβ is compared toimmunization with an Aβ variant molecule. It should be noted that theuse of a modified molecule does not exclude the possibility of usingsuch a modified amyloidogenic polypeptide in formulations which furtherfacilitate the breaking of autotolerance against the amyloidogenicpolypeptide, e.g. formulations containing adjuvants.

It has been shown (in Dalum I et al., 1996, J. Immunol. 157: 4796-4804)that potentially self-reactive B-lymphocytes recognizing self-proteinsare physiologically present in normal individuals. However, in order forthese B-lymphocytes to be induced to actually produce antibodiesreactive with the relevant self-proteins, assistance is needed fromcytokine producing T-helper lymphocytes (T_(H)-cells orT_(H)-lymphocytes). Normally this help is not provided becauseT-lymphocytes in general do not recognize T-cell epitopes derived fromself-proteins when presented by antigen presenting cells (APCs).However, by providing an element of “foreignness” in a self-protein(i.e. by introducing an immunologically significant modification),T-cells recognizing the foreign element are activated upon recognizingthe foreign epitope on an APC (such as, initially, a mononuclear cell).Polyclonal B-lymphocytes (which are also APCs) capable of recognisingself-epitopes on the modified self-protein also internalise the antigenand subsequently presents the foreign T-cell epitope(s) thereof, and theactivated T-lymphocytes subsequently provide cytokine help to theseself-reactive polyclonal B-lymphocytes. Since the antibodies produced bythese polyclonal B-lymphocytes are reactive with different epitopes onthe modified polypeptide, including those which are also present in thenative polypeptide, an antibody cross-reactive with the non-modifiedself-protein is induced. In conclusion, the T-lymphocytes can be led toact as if the population of polyclonal B-lymphocytes have recognised anentirely foreign antigen, whereas in fact only the inserted epitope(s)is/are foreign to the host. In this way, antibodies capable ofcross-reacting with non-modified self-antigens are induced.

Several ways of modifying a peptide self-antigen in order to obtainbreaking of autotolerance are known in the art. Hence, according to theinvention, the modification can include that

-   -   at least one foreign T-cell epitope is introduced, and/or    -   at least one first moiety is introduced which effects targeting        of the modified molecule to an antigen presenting cell (APC),        and/or    -   at least one second moiety is introduced which stimulates the        immune system, and/or    -   at least one third moiety is introduced which optimizes        presentation of the modified amyloidogenic polypeptide to the        immune system.

However, all these modifications should be carried out while maintaininga substantial fraction of the original B-lymphocyte epitopes in theamyloidogenic polypeptide, since the B-lymphocyte recognition of thenative molecule is thereby enhanced.

In one preferred embodiment, side groups (in the form of foreign T-cellepitopes or the above-mentioned first, second and third moieties) arecovalently or non-covalently introduced. This is to mean that stretchesof amino acid residues derived from the amyloidogenic polypeptide arederivatized without altering the primary amino acid sequence, or atleast without introducing changes in the peptide bonds between theindividual amino acids in the chain.

An alternative, and preferred, embodiment utilises amino acidsubstitution and/or deletion and/or insertion and/or addition (which maybe effected by recombinant means or by means of peptide synthesis;modifications which involves longer stretches of amino acids can giverise to fusion polypeptides). One especially preferred version of thisembodiment is the technique described in WO 95/05849, which discloses amethod for down-regulating self-proteins by immunising with analogues ofthe self-proteins wherein a number of amino acid sequence(s) has beensubstituted with a corresponding number of amino acid sequence(s) whicheach comprise a foreign immunodominant T-cell epitope, while at the sametime maintaining the overall tertiary structure of the self-protein inthe analogue. For the purposes of the present invention, it is howeversufficient if the modification (be it an insertion, addition, deletionor substitution) gives rise to a foreign T-cell epitope and at the sametime preserves a substantial number of the B-cell epitopes in theamyloidogenic polypeptide. However, in order to obtain maximum efficacyof the immune response induced, it is preferred that the overalltertiary structure of the amyloidogenic polypeptide is maintained in themodified molecule.

The following formula describes the molecular constructs generallycovered by the invention:

(MOD₁)_(s1)(amyloid_(e1))_(n1)(MOD₂)_(s2)(amyloid_(e2))_(n2) . . .(MOD_(x))_(sx)(amyloid_(ex))_(nx)  (I)

-   -   where amyloid_(e1)-amyloid_(ex) are x B-cell epitope containing        subsequences of an amyloidogenic polypeptide which independently        are identical or non-identical and which may contain or not        contain foreign side groups, x is an integer ≧3, n1-nx are x        integers ≧0 (at least one is ≧1), MOD₁-MOD_(x) are x        modifications introduced between the preserved B-cell epitopes,        and s₁-s_(x) are x integers ≧0 (at least one is ≧1 if no side        groups are introduced in the amyloid_(ex) sequences) Thus, given        the general functional restraints on the immunogenicity of the        constructs, the invention allows for all kinds of permutations        of the original sequence of the amyloidogenic polypeptide, and        all kinds of modifications therein. Thus, included in the        invention are modified amyloidogenic polypeptides obtained by        omission of parts of the sequence of the amyloidogenic        polypeptide which e.g. exhibit adverse effects in vivo or        omission of parts which are normally intracellular and thus        could give rise to undesired immunological reactions.

One preferred version of the constructs outlined above are, whenapplicable, those where the B-cell epitope containing subsequence of anamyloid protein is not extracellularly exposed in the precursorpolypeptide from which the amyloid is derived. By making such a choiceof the amyloid epitopes, it is ensured that antibodies are not generatedwhich would be reactive with the cells producing the amyloid precursorand thereby the immune response which is generated becomes limited to animmune response against the undesired amyloid deposits. A similar choicecan, when applicable, be made for other amyloidogenic polypeptides thanamyloid. In these cases it will e.g. be feasible to induce immunityagainst epitopes of the amyloidogenic polypeptide which are only exposedto the extracellular phase when being free from any coupling to thecells from which they are produced.

Maintenance of a substantial fraction of B-cell epitopes or even theoverall tertiary structure of a protein which is subjected tomodification as described herein can be achieved in several ways. One issimply to prepare a polyclonal anti-serum directed against theamyloidogenic polypeptide (e.g. an antiserum prepared in a rabbit) andthereafter use this antiserum as a test reagent (e.g. in a competitiveELISA) against the modified proteins which are produced. Modifiedversions (analogues) which react to the same extent with the antiserumas does the amyloidogenic polypeptide must be regarded as having thesame overall tertiary structure as the amyloidogenic polypeptide whereasanalogues exhibiting a limited (but still significant and specific)reactivity with such an antiserum are regarded as having maintained asubstantial fraction of the original B-cell epitopes.

Alternatively, a selection of monoclonal antibodies reactive withdistinct epitopes on the amyloidogenic polypeptide can be prepared andused as a test panel. This approach has the advantage of allowing 1) anepitope mapping of the amyloidogenic polypeptide and 2) a mapping of theepitopes which are maintained in the analogues prepared.

Of course, a third approach would be to resolve the 3-dimensionalstructure of the amyloidogenic polypeptide or of a biologically activetruncate thereof (cf. above) and compare this to the resolvedthree-dimensional structure of the analogues prepared. Three-dimensionalstructure can be resolved by the aid of X-ray diffraction studies andNMR-spectroscopy. Further information relating to the tertiary structurecan to some extent be obtained from circular dichroism studies whichhave the advantage of merely requiring the polypeptide in pure form(whereas X-ray diffraction requires the provision of crystallizedpolypeptide and NMR requires the provision of isotopic variants of thepolypeptide) in order to provide useful information about the tertiarystructure of a given molecule. However, ultimately X-ray diffractionand/or NMR are necessary to obtain conclusive data since circulardichroism can only provide indirect evidence of correct 3-dimensionalstructure via information of secondary structure elements.

One preferred embodiment of the invention utilises multiplepresentations of B-lymphocyte epitopes of the amyloidogenic polypeptide(i.e. formula I wherein at least one B-cell epitope is present in twopositions). This effect can be achieved in various ways, e.g. by simplypreparing fusion polypeptides comprising the structure (amyloidogenicpolypeptide)_(m), where m is an integer ≧2 and then introduce themodifications discussed herein in at least one of the amyloid sequences.It is preferred that the modifications introduced includes at least oneduplication of a B-lymphocyte epitope and/or the introduction of ahapten. These embodiments including multiple presentations of selectedepitopes are especially preferred in situations where merely minor partsof the amyloidogenic polypeptide are useful as constituents in a vaccineagent.

As mentioned above, the introduction of a foreign T-cell epitope can beaccomplished by introduction of at least one amino acid insertion,addition, deletion, or substitution. Of course, the normal situationwill be the introduction of more than one change in the amino acidsequence (e.g. insertion of or substitution by a complete T-cellepitope) but the important goal to reach is that the analogue, whenprocessed by an antigen presenting cell (APC), will give rise to such aforeign immunodominant T-cell epitope being presented in context of anMCH Class II molecule on the surface of the APC. Thus, if the amino acidsequence of the amyloidogenic polypeptide in appropriate positionscomprises a number of amino acid residues which can also be found in aforeign T_(H) epitope then the introduction of a foreign T_(H) epitopecan be accomplished by providing the remaining amino acids of theforeign epitope by means of amino acid insertion, addition, deletion andsubstitution. In other words, it is not necessary to introduce acomplete T_(H) epitope by insertion or substitution in order to fulfillthe purpose of the present invention.

It is preferred that the number of amino acid insertions, deletions,substitutions or additions is at least 2, such as 3, 4, 5, 6, 7, 8, 9,10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, and 25 insertions,substitutions, additions or deletions. It is furthermore preferred thatthe number of amino acid insertions, substitutions, additions ordeletions is not in excess of 150, such as at most 100, at most 90, atmost 80, and at most 70. It is especially preferred that the number ofsubstitutions, insertions, deletions, or additions does not exceed 60,and in particular the number should not exceed 50 or even 40. Mostpreferred is a number of not more than 30. With respect to amino acidadditions, it should be noted that these, when the resulting constructis in the form of a fusion polypeptide, is often considerably higherthan 150.

Preferred embodiments of the invention includes modification byintroducing at least one foreign immunodominant T-cell epitope. It willbe understood that the question of immune dominance of a T-cell epitopedepends on the animal species in question. As used herein, the term“immunodominance” simply refers to epitopes which in the vaccinatedindividual/population gives rise to a significant immune response, butit is a well-known fact that a T-cell epitope which is immunodominant inone individual/population is not necessarily immunodominant in anotherindividual of the same species, even though it may be capable of bindingMHC-II molecules in the latter individual. Hence, for the purposes ofthe present invention, an immune dominant T-cell epitope is a T-cellepitope which will be effective in providing T-cell help when present inan antigen. Typically, immune dominant T-cell epitopes has as aninherent feature that they will substantially always be presented boundto an MHC Class II molecule, irrespective of the polypeptide whereinthey appear.

Another important point is the issue of MHC restriction of T-cellepitopes. In general, naturally occurring T-cell epitopes are MHCrestricted, i.e. a certain peptides constituting a T-cell epitope willonly bind effectively to a subset of MHC Class II molecules. This inturn has the effect that in most cases the use of one specific T-cellepitope will result in a vaccine component which is only effective in afraction of the population, and depending on the size of that fraction,it can be necessary to include more T-cell epitopes in the samemolecule, or alternatively prepare a multi-component vaccine wherein thecomponents are variants of the amyloidogenic polypeptide which aredistinguished from each other by the nature of the T-cell epitopeintroduced.

If the MHC restriction of the T-cells used is completely unknown (forinstance in a situation where the vaccinated animal has a poorly definedMHC composition), the fraction of the population covered by a specificvaccine composition can be determined by means of the following formula

$\begin{matrix}{f_{population} = {1 - {\prod\limits_{l = 1}^{n}\left( {1 - p_{i}} \right)}}} & ({II})\end{matrix}$

-   -   where p_(i) is the frequency in the population of responders to        the i^(th) foreign T-cell epitope present in the vaccine        composition, and n is the total number of foreign T-cell        epitopes in the vaccine composition. Thus, a vaccine composition        containing 3 foreign T-cell epitopes having response frequencies        in the population of 0.8, 0.7, and 0.6, respectively, would give

1−0.2×0.3×0.4=0.976

-   -   i.e. 97.6 percent of the population will statistically mount an        MHC-II mediated response to the vaccine.

The above formula does not apply in situations where a more or lessprecise MHC restriction pattern of the peptides used is known. If, forinstance a certain peptide only binds the human MHC-II molecules encodedby HLA-DR alleles DR1, DR3, DR5, and DR7, then the use of this peptidetogether with another peptide which binds the remaining MHC-II moleculesencoded by HLA-DR alleles will accomplish 100% coverage in thepopulation in question. Likewise, if the second peptide only binds DR3and DR5, the addition of this peptide will not increase the coverage atall. If one bases the calculation of population response purely on MHCrestriction of T-cell epitopes in the vaccine, the fraction of thepopulation covered by a specific vaccine composition can be determinedby means of the following formula:

$\begin{matrix}{f_{population} = {1 - {\prod\limits_{j = 1}^{3}\left( {1 - \phi_{j}} \right)^{2}}}} & ({III})\end{matrix}$

-   -   wherein φ_(j) is the sum of frequencies in the population of        allelic haplotypes encoding MHC molecules which bind any one of        the T-cell epitopes in the vaccine and which belong to the        j^(th) of the 3 known HLA loci (DP, DR and DQ); in practice, it        is first determined which MHC molecules will recognize each        T-cell epitope in the vaccine and thereafter these are listed by        type (DP, DR and DQ)—then, the individual frequencies of the        different listed allelic haplotypes are summed for each type,        thereby yielding φ₁, φ₂, and φ₃.

It may occur that the value p_(i) in formula II exceeds thecorresponding theoretical value p_(i):

$\begin{matrix}{\pi_{i} = {1 - {\prod\limits_{j = 1}^{3}\left( {1 - v_{j}} \right)^{2}}}} & ({IV})\end{matrix}$

-   -   wherein u_(j) is the sum of frequencies in the population of        allelic haplotype encoding MHC molecules which bind the i^(th)        T-cell epitope in the vaccine and which belong to the j^(th) of        the 3 known HLA loci (DP, DR and DQ). This means that in 1−p_(i)        of the population is a frequency of responders of f_(residual)        _(—) _(i)=(p_(i)−p_(i))/(1−p_(i)). Therefore, formula III can be        adjusted so as to yield formula V:

$\begin{matrix}{f_{population} = {1 - {\prod\limits_{j = 1}^{3}\left( {1 - \phi_{j}} \right)^{2}} + \left( {1 - {\prod\limits_{l = 1}^{n}\left( {1 - f_{residual\_ i}} \right)}} \right)}} & (V)\end{matrix}$

-   -   where the term 1−φ_(residual) _(—) _(i) is set to zero if        negative. It should be noted that formula V requires that all        epitopes have been haplotype mapped against identical sets of        haplotypes.

Therefore, when selecting T-cell epitopes to be introduced in theanalogue, it is important to include all knowledge of the epitopes whichis available: 1) The frequency of responders in the population to eachepitope, 2) MHC restriction data, and 3) frequency in the population ofthe relevant haplotypes.

There exist a number of naturally occurring “promiscuous” T-cellepitopes which are active in a large proportion of individuals of ananimal species or an animal population and these are preferablyintroduced in the vaccine thereby reducing the need for a very largenumber of different analogues in the same vaccine.

The promiscuous epitope can according to the invention be a naturallyoccurring human T-cell epitope such as epitopes from tetanus toxoid(e.g. the P2 and P30 epitopes), diphtheria toxoid, Influenza virushemaglutinin (HA), and P. falciparum CS antigen.

Over the years a number of other promiscuous T-cell epitopes have beenidentified. Especially peptides capable of binding a large proportion ofHLA-DR molecules encoded by the different HLA-DR alleles have beenidentified and these are all possible T-cell epitopes to be introducedin the analogues used according to the present invention. Cf. also theepitopes discussed in the following references which are hereby allincorporated by reference herein: WO 98/23635 (Frazer I H et al.,assigned to The University of Queensland); Southwood S et. al, 1998, J.Immunol. 160: 3363-3373; Sinigaglia P et al., 1988, Nature 336: 778-780;Chicz R M et al., 1993, J. Exp. Med 178: 27-47; Hammer J et al., 1993,Cell 74: 197-203; and Falk K et al., 1994, Immunogenetics 39: 230-242.The latter reference also deals with HLA-DQ and -DP ligands. Allepitopes listed in these 5 references are relevant as candidate naturalepitopes to be used in the present invention, as are epitopes whichshare common motifs with these.

Alternatively, the epitope can be any artificial T-cell epitope which iscapable of binding a large proportion of MHC Class II molecules. In thiscontext the pan DR epitope peptides (“PADRE”) described in WO 95/07707and in the corresponding paper Alexander J et al., 1994, Immunity 1:751-761 (both disclosures are incorporated by reference herein) areinteresting candidates for epitopes to be used according to the presentinvention. It should be noted that the most effective PADRE peptidesdisclosed in these papers carry D-amino acids in the C- and N-termini inorder to improve stability when administered. However, the presentinvention primarily aims at incorporating the relevant epitopes as partof the modified amyloidogenic polypeptide which should then subsequentlybe broken down enzymatically inside the lysosomal compartment of APCs toallow subsequent presentation in the context of an MHC-II molecule andtherefore it is not expedient to incorporate D-amino acids in theepitopes used in the present invention.

One especially preferred PADRE peptide is the one having the amino acidsequence AKFVAAWTLKAAA or an immunologically effective subsequencethereof. This, and other epitopes having the same lack of MHCrestriction are preferred T-cell epitopes which should be present in theanalogues used in the inventive method. Such super-promiscuous epitopeswill allow for the most simple embodiments of the invention wherein onlyone single modified amyloidogenic polypeptide is presented to thevaccinated animal's immune system.

As mentioned above, the modification of the amyloidogenic polypeptidecan also include the introduction of a first moiety which targets themodified amyloidogenic polypeptide to an APC or a B-lymphocyte. Forinstance, the first moiety can be a specific binding partner for aB-lymphocyte specific surface antigen or for an APC specific surfaceantigen. Many such specific surface antigens are known in the art. Forinstance, the moiety can be a carbohydrate for which there is a receptoron the B-lymphocyte or the APC (e.g. mannan or mannose). Alternatively,the second moiety can be a hapten. Also an antibody fragment whichspecifically recognizes a surface molecule on APCs or lymphocytes can beused as a first moiety (the surface molecule can e.g. be an FCγ receptorof macrophages and monocytes, such as FCγRI or, alternatively any otherspecific surface marker such as CD40 or CTLA-4). It should be noted thatall these exemplary targeting molecules can be used as part of anadjuvant also, cf. below.

As an alternative or supplement to targeting the modified amyloidogenicpolypeptide to a certain cell type in order to achieve an enhancedimmune response, it is possible to increase the level of responsivenessof the immune system by including the above-mentioned second moietywhich stimulates the immune system. Typical examples of such secondmoieties are cytokines, and heat-shock proteins or molecular chaperones,as well as effective parts thereof.

Suitable cytokines to be used according to the invention are those whichwill normally also function as adjuvants in a vaccine composition, i.e.for instance interferon γ (IFN-γ), interleukin 1 (IL-1), interleukin 2(IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 12(IL-12), interleukin 13 (IL-13), interleukin 15 (IL-15), andgranulocyte-macrophage colony stimulating factor (GM-CSF);alternatively, the functional part of the cytokine molecule may sufficeas the second moiety. With respect to the use of such cytokines asadjuvant substances, cf. the discussion below.

According to the invention, suitable heat-shock proteins or molecularchaperones used as the second moiety can be HSP70, HSP90, HSC70, GRP94(also known as gp96, cf. Wearsch P A et al. 1998, Biochemistry 37:5709-19), and CRT (calreticulin).

Alternatively, the second moiety can be a toxin, such as listeriolycin(LLO), lipid A and heat-labile enterotoxin. Also, a number ofmycobacterial derivatives such as MDP (muramyl dipeptide), CFA (completeFreund's adjuvant) and the trehalose diesters TDM and TDE areinteresting possibilities.

Also the possibility of introducing a third moiety which enhances thepresentation of the modified amyloidogenic polypeptide to the immunesystem is an important embodiment of the invention. The art has shownseveral examples of this principle. For instance, it is known that thepalmitoyl lipidation anchor in the Borrelia burgdorferi protein OspA canbe utilised so as to provide self-adjuvating polypeptides (cf. e.g. WO96/40718)—it seems that the lipidated proteins form up micelle-likestructures with a core consisting of the lipidation anchor parts of thepolypeptides and the remaining parts of the molecule protrudingtherefrom, resulting in multiple presentations of the antigenicdeterminants. Hence, the use of this and related approaches usingdifferent lipidation anchors (e.g. a myristyl group, a myristyl group, afarnesyl group, a geranyl-geranyl group, a GPI-anchor, and an N-acyldiglyceride group) are preferred embodiments of the invention,especially since the provision of such a lipidation anchor in arecombinantly produced protein is fairly straightforward and merelyrequires use of e.g. a naturally occurring signal sequence as a fusionpartner for the modified amyloidogenic polypeptide. Another possibilityis use of the C3d fragment of complement factor C3 or C3 itself (cf.Dempsey et al., 1996, Science 271, 348-350 and Lou & Kohler, 1998,Nature Biotechnology 16, 458-462).

An alternative embodiment of the invention which also results in thepreferred presentation of multiple (e.g. at least 2) copies of theimportant epitopic regions of the amyloidogenic polypeptide to theimmune system is the covalent coupling of the amyloidogenic polypeptide,subsequence or variants thereof to certain molecules. For instance,polymers can be used, e.g. carbohydrates such as dextran, cf. e.g. LeesA et al., 1994, Vaccine 12: 1160-1166; Lees A et al., 1990, J Immunol.145: 3594-3600, but also mannose and mannan are useful alternative.Integral membrane proteins from e.g. E. coli and other bacteria are alsouseful conjugation partners. The traditional carrier molecules such askeyhole limpet hemocyanin (KLH), tetanus toxoid, diphtheria toxoid, andbovine serum albumin (BSA) are also preferred and useful conjugationpartners.

Preferred embodiments of covalent coupling of the amyloidogenicpolypeptide to polyhydroxypolymers such as carbohydrates involve the useof at least one amyloidogenic polypeptide and at least one foreignT-helper epitope which are coupled separately to the polyhydroxypolymer(i.e. the foreign T-helper epitope and the amyloidogenic polypeptide arenot fused to each other but rather bound to the polyhydroxypolymer whichthen serves as a carrier backbone). Again, such an embodiment is mostpreferred when the suitable B-cell epitope carrying regions of theamyloidogenic polypeptide are constituted by short peptidestretches—this is because this approach is one very convenient way toachieve multiple presentations of selected epitopes in the resultingimmunogenic agent.

It is especially preferred that the coupling of the foreign T-helperepitope and the amyloidogenic (poly)peptide is by means of an amide bondwhich can be cleaved by a peptidase. This strategy has the effect thatAPCs will be able to take up the conjugate and at the same time be ableto process the conjugate and subsequently present the foreign T-cellepitope in an MHC Class II context.

One way of achieving coupling of peptides (both the amyloidogenicpolypeptide and the foreign epitope) is to activate a suitablepolyhydroxypolymer with tresyl groups; it is e.g. possible to preparetresylated polysaccharides as described in WO 00/05316 and U.S. Pat. No.5,674,469 (both incorporated by reference herein) and couple these toamyloidogenic peptides and T-cell epitopes prepared by means ofconventional solid or liquid phase peptide synthesis techniques. Theresulting product consists of a polyhydroxypolymer backbone (e.g. adextran backbone) that has, attached thereto by their N-termini or byother available nitrogen moieties, amyloidogenic polypeptides andforeign T-cell epitopes. If desired, it is possible to synthesise theamyloidogenic polypeptides so as to protect all available amino groupsbut the one at the N-terminus, subsequently couple the resultingprotected peptides to the tresylated dextran moiety, and finallydeprotecting the resulting conjugate. A specific example of thisapproach is described in the examples below.

Instead of using the water-soluble polysaccharide molecules as taught inWO 00/05316 and U.S. Pat. No. 5,874,469, it is equally possible toutilise cross-linked polysaccharide molecules, thereby obtaining aparticulate conjugate between polypeptides and polysaccharide—this isbelieved to lead to an improved presentation to the immune system of thepolypeptides, since two goals are reached, namely to obtain a localdeposit effect when injecting the conjugate and to obtain particleswhich are attractive targets for APCs. The approach of using suchparticulate systems is also detailed in the examples.

Considerations underlying chosen areas of introducing modifications inamyloidogenic polypeptides are a) preservation of known and predictedB-cell epitopes, b) preservation of tertiary structure, c) avoidance ofB-cell epitopes present on “producer cells” etc. At any rate, asdiscussed above, it is fairly easy to screen a set of modifiedamyloidogenic molecules which have all been subjected to introduction ofa T-cell epitope in different locations.

Since the most preferred embodiments of the present invention involvedown-regulation of human Aβ, it is consequently preferred that theamyloid polypeptide discussed above is a human Aβ polypeptide. In thisembodiment, it is especially preferred that the human amyloidogenicpolypeptide has been modified by substituting at least one amino acidsequence in SEQ ID NO: 2 with at least one amino acid sequence of equalor different length and containing a foreign T_(H) epitope. Preferredexamples of modified amyloidogenic APP and Aβ are shown schematically inFIG. 1 using the P2 and P30 epitopes as examples. The rationale behindsuch constructs is discussed in detail in the example.

More specifically, a T_(H) containing (or completing) amino acidsequence which is introduced into SEQ ID NO: 2 may be introduced at anyamino acid in SEQ ID NO: 2. That is, the introduction is possible afterany of amino acids 1-770, but preferably after any of amino acids 671,672, 673, 674, 675, 676, 677, 678, 679, 680, 681, 682, 683, 684, 685,686, 687, 688, 689, 690, 691, 692, 693, 694, 695, 696, 697, 698, 699,700, 701, 702, 703, 704, 705, 706, 707, 708, 709, 710, 711, 712, 713,and 714 in SEQ ID NO: 2. This may be combined with deletion of any orall of amino acids 1-671, or any of all of amino acids 715-770.Furthermore, when utilising the technique of substitution, any one ofamino acids 671, 672, 673, 674, 675, 676, 677, 678, 679, 680, 681, 682,683, 684, 685, 686, 687, 688, 689, 690, 691, 692, 693, 694, 695, 696,697, 698, 699, 700, 701, 702, 703, 704, 705, 706, 707, 708, 709, 710,711, 712, 713, and 714 in SEQ ID NO: 2 may be deleted in combinationwith the introduction.

Formulation of the Amyloidogenic Polypeptide and Modified AmyloidogenicPolypeptides

When effecting presentation of the amyloidogenic polypeptide or themodified amyloidogenic polypeptide to an animal's immune system by meansof administration thereof to the animal, the formulation of thepolypeptide follows the principles generally acknowledged in the art.

Preparation of Vaccines which Contain Peptide Sequences as activeingredients is generally well understood in the art, as exemplified byU.S. Pat. Nos. 4,608,251; 4,601,903; 4,599,231; 4,599,230; 4,596,792;and 4,578,770, all incorporated herein by reference. Typically, suchvaccines are prepared as injectables either as liquid solutions orsuspensions; solid forms suitable for solution in, or suspension in,liquid prior to injection may also be prepared. The preparation may alsobe emulsified. The active immunogenic ingredient is often mixed withexcipients which are pharmaceutically acceptable and compatible with theactive ingredient. Suitable excipients are, for example, water, saline,dextrose, glycerol, ethanol, or the like, and combinations thereof. Inaddition, if desired, the vaccine may contain minor amounts of auxiliarysubstances such as wetting or emulsifying agents, pH buffering agents,or adjuvants which enhance the effectiveness of the vaccines; cf. thedetailed discussion of adjuvants below.

The vaccines are conventionally administered parenterally, by injection,for example, either subcutaneously, intracutaneously, intradermally,subdermally or intramuscularly. Additional formulations which aresuitable for other modes of administration include suppositories and, insome cases, oral, buccal, sublingual, intraperitoneal, intravaginal,anal, epidural, spinal, and intracranial formulations. Forsuppositories, traditional binders and carriers may include, forexample, polyalkalene glycols or triglycerides; such suppositories maybe formed from mixtures containing the active ingredient in the range of0.5% to 10%, preferably 1-2%. Oral formulations include such normallyemployed excipients as, for example, pharmaceutical grades of mannitol,lactose, starch, magnesium stearate, sodium saccharine, cellulose,magnesium carbonate, and the like. These compositions take the form ofsolutions, suspensions, tablets, pills, capsules, sustained releaseformulations or powders and contain 10-95% of active ingredient,preferably 25-70%. For oral formulations, cholera toxin is aninteresting formulation partner (and also a possible conjugationpartner).

The polypeptides may be formulated into the vaccine as neutral or saltforms. Pharmaceutically acceptable salts include acid addition salts(formed with the free amino groups of the peptide) and which are formedwith inorganic acids such as, for example, hydrochloric or phosphoricacids, or such organic acids as acetic, oxalic, tartaric, mandelic, andthe like. Salts formed with the free carboxyl groups may also be derivedfrom inorganic bases such as, for example, sodium, potassium, ammonium,calcium, or ferric hydroxides, and such organic bases as isopropylamine,trimethylamine, 2-ethylamino ethanol, histidine, procaine, and the like.

The vaccines are administered in a manner compatible with the dosageformulation, and in such amount as will be therapeutically effective andimmunogenic. The quantity to be administered depends on the subject tobe treated, including, e.g., the capacity of the individual's immunesystem to mount an immune response, and the degree of protectiondesired. Suitable dosage ranges are of the order of several hundredmicrograms active ingredient per vaccination with a preferred range fromabout 0.1 μg to 2,000 μg (even though higher amounts in the 1-10 mgrange are contemplated), such as in the range from about 0.5 μg to 1,000μg, preferably in the range from 1 μg to 500 μg and especially in therange from about 10 μg to 100 μg. Suitable regimens for initialadministration and booster shots are also variable but are typified byan initial administration followed by subsequent inoculations or otheradministrations.

The manner of application may be varied widely. Any of the conventionalmethods for administration of a vaccine are applicable. These includeoral application on a solid physiologically acceptable base or in aphysiologically acceptable dispersion, parenterally, by injection or thelike. The dosage of the vaccine will depend on the route ofadministration and will vary according to the age of the person to bevaccinated and the formulation of the antigen.

Some of the polypeptides of the vaccine are sufficiently immunogenic ina vaccine, but for some of the others the immune response will beenhanced if the vaccine further comprises an adjuvant substance.

Various methods of achieving adjuvant effect for the vaccine are known.General principles and methods are detailed in “The Theory and PracticalApplication of Adjuvants”, 1995, Duncan E. S. Stewart-Tull (ed.), JohnWiley & Sons Ltd, ISBN 0-471-95170-6, and also in “Vaccines: NewGeneration Immunological Adjuvants”, 1995, Gregoriadis G et al. (eds.),Plenum Press, New York, ISBN 0-306-45283-9, both of which are herebyincorporated by reference herein.

It is especially preferred to use an adjuvant which can be demonstratedto facilitate breaking of the autotolerance to autoantigens; in fact,this is essential in cases where unmodified amyloidogenic polypeptide isused as the active ingredient in the autovaccine. Non-limiting examplesof suitable adjuvants are selected from the group consisting of animmune targeting adjuvant; an immune modulating adjuvant such as atoxin, a cytokine, and a mycobacterial derivative; an oil formulation; apolymer; a micelle forming adjuvant; a saponin; an immunostimulatingcomplex matrix (ISCOM matrix); a particle; DDA; aluminium adjuvants; DNAadjuvants; γ-inulin; and an encapsulating adjuvant. In general it shouldbe noted that the disclosures above which relate to compounds and agentsuseful as first, second and third moieties in the analogues also refermutatis mutandis to their use in the adjuvant of a vaccine of theinvention.

The application of adjuvants include use of agents such as aluminumhydroxide or phosphate (alum), commonly used as 0.05 to 0.1 percentsolution in buffered saline, admixture with synthetic polymers of sugars(e.g. Carbopol®) used as 0.25 percent solution, aggregation of theprotein in the vaccine by heat treatment with temperatures rangingbetween 70° to 101° C. for 30 second to 2 minute periods respectivelyand also aggregation by means of cross-linking agents are possible.Aggregation by reactivation with pepsin treated antibodies (Fabfragments) to albumin, mixture with bacterial cells such as C. parvum orendotoxins or lipopolysaccharide components of gram-negative bacteria,emulsion in physiologically acceptable oil vehicles such as mannidemono-oleate (Aracel A) or emulsion with 20 percent solution of aperfluorocarbon (Fluosol-DA) used as a block substitute may also beemployed. Admixture with oils such as squalene and IFA is alsopreferred.

According to the invention DDA (dimethyldioctadecylammonium bromide) isan interesting candidate for an adjuvant as is DNA and γ-inulin, butalso Freund's complete and incomplete adjuvants as well as quillajasaponins such as QuilA and QS21 are interesting as is RIBI. Furtherpossibilities are monophosphoryl lipid A (MPL), the above mentioned C3and C3d, and muramyl dipeptide (MDP).

Liposome formulations are also known to confer adjuvant effects, andtherefore liposome adjuvants are preferred according to the invention.

Also immunostimulating complex matrix type (ISCOM® matrix) adjuvants arepreferred choices according to the invention, especially since it hasbeen shown that this type of adjuvants are capable of up-regulating MHCClass II expression by APCs. An ISCOM® matrix consists of (optionallyfractionated) saponins (triterpenoids) from Quillaja saponaria,cholesterol, and phospholipid. When admixed with the immunogenicprotein, the resulting particulate formulation is what is known as anISCOM particle where the saponin constitutes 60-70% w/w, the cholesteroland phospholipid 10-15% w/w, and the protein 10-15% w/w. Detailsrelating to composition and use of immunostimulating complexes can e.g.be found in the above-mentioned text-books dealing with adjuvants, butalso Morein B et al., 1995, Clin. Immunother. 3: 461-475 as well as BarrI G and Mitchell G F, 1996, Immunol. and Cell Biol. 74: 8-25 (bothincorporated by reference herein) provide useful instructions for thepreparation of complete immunostimulating complexes.

Another highly interesting (and thus, preferred) possibility ofachieving adjuvant effect is to employ the technique described inGosselin et al., 1992 (which is hereby incorporated by referenceherein). In brief, the presentation of a relevant antigen such as anantigen of the present invention can be enhanced by conjugating theantigen to antibodies (or antigen binding antibody fragments) againstthe Fcγ receptors on monocytes/macrophages. Especially conjugatesbetween antigen and anti-FcγRI have been demonstrated to enhanceimmunogenicity for the purposes of vaccination.

Other possibilities involve the use of the targeting and immunemodulating substances (i.a. cytokines) mentioned above as candidates forthe first and second moieties in the modified versions of amyloidogenicpolypeptides. In this connection, also synthetic inducers of cytokineslike poly I:C are possibilities.

Suitable mycobacterial derivatives are selected from the groupconsisting of muramyl dipeptide, complete Freund's adjuvant, RIBI, and adiester of trehalose such as TDM and TDE.

Suitable immune targeting adjuvants are selected from the groupconsisting of CD40 ligand and CD40 antibodies or specifically bindingfragments thereof (cf. the discussion above), mannose, a Fab fragment,and CTLA-4.

Suitable polymer adjuvants are selected from the group consisting of acarbohydrate such as dextran, PEG, starch, mannan, and mannose; aplastic polymer such as; and latex such as latex beads.

Yet another interesting way of modulating an immune response is toinclude the immunogen (optionally together with adjuvants andpharmaceutically acceptable carriers and vehicles) in a “virtual lymphnode” (VLN) (a proprietary medical device developed by ImmunoTherapy,Inc., 360 Lexington Avenue, New York, N.Y. 10017-6501). The VLN (a thintubular device) mimics the structure and function of a lymph node.Insertion of a VLN under the skin creates a site of sterile inflammationwith an upsurge of cytokines and chemokines. T- and B-cells as well asAPCs rapidly respond to the danger signals, home to the inflamed siteand accumulate inside the porous matrix of the VLN. It has been shownthat the necessary antigen dose required to mount an immune response toan antigen is reduced when using the VLN and that immune protectionconferred by vaccination using a VLN surpassed conventional immunizationusing Ribi as an adjuvant. The technology is i.a. described briefly inGelber C et al., 1998, “Elicitation of Robust Cellular and HumoralImmune Responses to Small Amounts of Immunogens Using a Novel MedicalDevice Designated the Virtual Lymph Node”, in: “From the Laboratory tothe Clinic, Book of Abstracts, Oct. 12-15, 1998, Seascape Resort, Aptos,Calif.”.

Microparticle formulation of vaccines has been shown in many cases toincrease the immunogenicity of protein antigens and is therefore anotherpreferred embodiment of the invention. Microparticles are made either asco-formulations of antigen with a polymer, a lipid, a carbohydrate orother molecules suitable for making the particles, or the microparticlescan be homogeneous particles consisting of only the antigen itself.

Examples of polymer based microparticles are PLGA and PVP basedparticles (Gupta, R. K. et. al. 1998) where the polymer and the antigenare condensed into a solid particle. Lipid based particles can be madeas micelles of the lipid (so-called liposomes) entrapping the antigenwithin the micelle (Pietrobon, P. J. 1995). Carbohydrate based particlesare typically made of a suitable degradable carbohydrate such as starchor chitosan. The carbohydrate and the antigen are mixed and condensedinto particles in a process similar to the one used for polymerparticles (Kas, H. S. et. al. 1997).

Particles consisting only of the antigen can be made by various sprayingand freeze-drying techniques. Especially suited for the purposes of thepresent invention is the super critical fluid technology that is used tomake very uniform particles of controlled size (York, P. 1999 &Shekunov, B. et. al. 1999).

It is expected that the vaccine should be administered 1-6 times peryear, such as 1, 2, 3, 4, 5, or 6 times a year to an individual in needthereof. It has previously been shown that the memory immunity inducedby the use of the preferred autovaccines according to the invention isnot permanent, and therefore the immune system needs to be periodicallychallenged with the amyloidogenic polypeptide or modified amyloidogenicpolypeptides.

Due to genetic variation, different individuals may react with immuneresponses of varying strength to the same polypeptide. Therefore, thevaccine according to the invention may comprise several differentpolypeptides in order to increase the immune response, cf. also thediscussion above concerning the choice of foreign T-cell epitopeintroductions. The vaccine may comprise two or more polypeptides, whereall of the polypeptides are as defined above.

The vaccine may consequently comprise 3-20 different modified orunmodified polypeptides, such as 3-10 different polypeptides.

Nucleic Acid Vaccination

As an alternative to classic administration of a peptide-based vaccine,the technology of nucleic acid vaccination (also known as “nucleic acidimmunisation”, “genetic immunisation”, and “gene immunisation”) offers anumber of attractive features.

First, in contrast to the traditional vaccine approach, nucleic acidvaccination does not require resource consuming large-scale productionof the immunogenic agent (e.g. in the form of industrial scalefermentation of microorganisms producing modified amyloidogenicpolypeptides). Furthermore, there is no need to device purification andrefolding schemes for the immunogen. And finally, since nucleic acidvaccination relies on the biochemical apparatus of the vaccinatedindividual in order to produce the expression product of the nucleicacid introduced, the optimum post-translational processing of theexpression product is expected to occur; this is especially important inthe case of autovaccination, since, as mentioned above, a significantfraction of the original B-cell epitopes should be preserved in themodified molecule, and since B-cell epitopes in principle can beconstituted by parts of any (bio)molecule (e.g. carbohydrate, lipid,protein etc.). Therefore, native glycosylation and lipidation patternsof the immunogen may very well be of importance for the overallimmunogenicity and this is best ensured by having the host producing theimmunogen.

Hence, a preferred embodiment of the invention comprises effectingpresentation of modified amyloidogenic polypeptide to the immune systemby introducing nucleic acid(s) encoding the modified amyloidogenicpolypeptide into the animal's cells and thereby obtaining in vivoexpression by the cells of the nucleic acid(s) introduced.

In this embodiment, the introduced nucleic acid is preferably DNA whichcan be in the form of naked DNA, DNA formulated with charged oruncharged lipids, DNA formulated in liposomes, DNA included in a viralvector, DNA formulated with a transfection-facilitating protein orpolypeptide, DNA formulated with a targeting protein or polypeptide, DNAformulated with Calcium precipitating agents, DNA coupled to an inertcarrier molecule, DNA encapsulated in a polymer, e.g. in PLGA (cf. themicroencapsulation technology described in WO 98/31398) or in chitin orchitosan, and DNA formulated with an adjuvant. In this context it isnoted that practically all considerations pertaining to the use ofadjuvants in traditional vaccine formulation apply for the formulationof DNA vaccines. Hence, all disclosures herein which relate to use ofadjuvants in the context of polypeptide based vaccines apply mutatismutandis to their use in nucleic acid vaccination technology.

As for routes of administration and administration schemes ofpolypeptide based vaccines which have been detailed above, these arealso applicable for the nucleic acid vaccines of the invention and alldiscussions above pertaining to routes of administration andadministration schemes for polypeptides apply mutatis mutandis tonucleic acids. To this should be added that nucleic acid vaccines cansuitably be administered intravenously and intraarterially. Furthermore,it is well-known in the art that nucleic acid vaccines can beadministered by use of a so-called gene gun, and hence also this andequivalent modes of administration are regarded as part of the presentinvention. Finally, also the use of a VLN in the administration ofnucleic acids has been reported to yield good results, and thereforethis particular mode of administration is particularly preferred.

Furthermore, the nucleic acid(s) used as an immunization agent cancontain regions encoding the 1^(st), 2^(nd) and/or 3^(rd) moieties, e.g.in the form of the immunomodulating substances described above such asthe cytokines discussed as useful adjuvants. A preferred version of thisembodiment encompasses having the coding region for the analogue and thecoding region for the immunomodulator in different reading frames or atleast under the control of different promoters. Thereby it is avoidedthat the analogue or epitope is produced as a fusion partner to theimmunomodulator. Alternatively, two distinct nucleotide fragments can beused, but this is less preferred because of the advantage of ensuredco-expression when having both coding regions included in the samemolecule.

Accordingly, the invention also relates to a composition for inducingproduction of antibodies against an amyloidogenic polypeptide, thecomposition comprising

-   -   a nucleic acid fragment or a vector of the invention (cf. the        discussion of vectors below), and    -   a pharmaceutically and immunologically acceptable vehicle and/or        carrier and/or adjuvant as discussed above.

Under normal circumstances, the variant-encoding nucleic acid isintroduced in the form of a vector wherein expression is under controlof a viral promoter. For more detailed discussions of vectors accordingto the invention, cf. the discussion below. Also, detailed disclosuresrelating to the formulation and use of nucleic acid vaccines areavailable, cf. Donnelly J J et al., 1997, Annu. Rev. Immunol. 15:617-648 and Donnelly J J et al., 1997, Life Sciences 60: 163-172. Bothof these references are incorporated by reference herein.

Live Vaccines

A third alternative for effecting presentation of modified amyloidogenicpolypeptide to the immune system is the use of live vaccine technology.In live vaccination, presentation to the immune system is effected byadministering, to the animal, a non-pathogenic microorganism which hasbeen transformed with a nucleic acid fragment encoding a modifiedamyloidogenic polypeptide or with a vector incorporating such a nucleicacid fragment. The non-pathogenic microorganism can be any suitableattenuated bacterial strain (attenuated by means of passaging or bymeans of removal of pathogenic expression products by recombinant DNAtechnology), e.g. Mycobacterium bovis BCG., non-pathogenic Streptococcusspp., E. coli, Salmonella spp., Vibrio cholerae, Shigella, etc. Reviewsdealing with preparation of state-of-the-art live vaccines can e.g. befound in Saliou P, 1995, Rev. Prat. 45; 1492-1496 and Walker P D, 1992,Vaccine 10: 977-990, both incorporated by reference herein. For detailsabout the nucleic acid fragments and vectors used in such live vaccines,cf. the discussion below.

As an alternative to bacterial live vaccines, the nucleic acid fragmentof the invention discussed below can be incorporated in a non-virulentviral vaccine vector such as a vaccinia strain or any other suitable poxvirus.

Normally, the non-pathogenic microorganism or virus is administered onlyonce to the animal, but in certain cases it may be necessary toadminister the microorganism more than once in a lifetime in order tomaintain protective immunity. It is even contemplated that immunizationschemes as those detailed above for polypeptide vaccination will beuseful when using live or virus vaccines.

Alternatively, live or virus vaccination is combined with previous orsubsequent polypeptide and/or nucleic acid vaccination. For instance, itis possible to effect primary immunization with a live or virus vaccinefollowed by subsequent booster immunizations using the polypeptide ornucleic acid approach.

The microorganism or virus can be transformed with nucleic acid(s)containing regions encoding the 1^(st), 2^(nd) and/or 3^(rd) moieties,e.g. in the form of the immunomodulating substances described above suchas the cytokines discussed as useful adjuvants. A preferred version ofthis embodiment encompasses having the coding region for the analogueand the coding region for the immunomodulator in different readingframes or at least under the control of different promoters. Thereby itis avoided that the analogue or epitopes are produced as fusion partnersto the immunomodulator. Alternatively, two distinct nucleotide fragmentscan be used as transforming agents. Of course, having the 1^(st) and/or2^(nd) and/or 3^(rd) moieties in the same reading frame can provide asan expression product, an analogue of the invention, and such anembodiment is especially preferred according to the present invention.

Use of the Method of the Invention in Disease Treatment

As will be appreciated from the discussions above, the provision of themethod of the invention allows for control of diseases characterized byamyloid deposits. In this context, AD is the key target for theinventive method but also other diseases characterized by amyloiddeposits are feasible targets. Hence, an important embodiment of themethod of the invention for down-regulating amyloid activity comprisestreating and/or preventing and/or ameliorating AD or other diseasescharacterized by amyloid deposition, the method comprisingdown-regulating amyloid according to the method of the invention to suchan extent that the amount of amyloid is significantly decreased.

It is especially preferred that the reduction in amyloid results in aninversion of the balance between amyloid formation and amyloiddegradation/removal, i.e. that the rate of amyloid degradation/removalis brought to exceed the rate of amyloid formation. By carefullycontrolling the number and immunological impact of immunizations of theindividual in need thereof it will be possible to obtain a balance overtime which results in a net reduction of amyloid deposits without havingexcessive adverse effects.

Alternatively, if in an individual the method of the invention cannotremove or reduce existing amyloid deposits, the method of the inventioncan be used to obtain a clinically significant reduction in theformation of new amyloid, thereby significantly prolonging the timewhere the disease condition is non-debilitating. It should be possibleto monitor the rate of amyloid depositing by either measuring the serumconcentration of amyloid (which is believed to be in equilibrium withthe deposited material), or by using positron-emission tomography (PET)scanning, cf. Small G W, et al., 1996, Ann N Y Acad Sci 802: 70-78.

Other diseases and conditions where the present means and methods may beused in treatment or amelioration in an analogous way have beenmentioned above in the “Background of the invention” (systemicamyloidosis, maturity onset diabetes, Parkinson's disease, Huntington'sdisease, fronto-temporal dementia and the prion-related transmissiblespongiform encephalopathies) or are listed below in the section headed“other amyloidic diseases and proteins associated therewith”.

Peptides, Polypeptides, and Compositions of the Invention

As will be apparent from the above, the present invention is based onthe concept of immunising individuals against the amyloidogenic antigenin order to obtain a reduced amount of pathology-related amyloiddeposits. The preferred way of obtaining such an immunization is to usemodified versions of amyloidogenic polypeptide, thereby providingmolecules which have not previously been disclosed in the art.

It is believed that the modified molecules discussed herein areinventive in their own right, and therefore an important part of theinvention pertains to an analogue which is derived from an animalamyloidogenic polypeptide wherein is introduced a modification which hasas a result that immunization of the animal with the analogue inducesproduction of antibodies reacting specifically with the unmodifiedamyloidogenic polypeptide. Preferably, the nature of the modificationconforms with the types of modifications described above when discussingvarious embodiments of the method of the invention when using modifiedamyloidogenic polypeptide. Hence, any disclosure presented hereinpertaining to modified amyloidogenic molecules are relevant for thepurpose of describing the amyloidogenic analogues of the invention, andany such disclosures apply mutatis mutandis to the description of theseanalogues.

It should be noted that preferred modified amyloidogenic moleculescomprises modifications which results in a polypeptide having a sequenceidentity of at least 70% with an amyloidogenic protein or with asubsequence thereof of at least 10 amino acids in length. Highersequence identities are preferred, e.g. at least 75% or even at least80, 85, 90, or 95%. The sequence identity for proteins and nucleic acidscan be calculated as (N_(ref)−N_(dif))·100/N_(ref), wherein N_(dif) isthe total number of non-identical residues in the two sequences whenaligned and wherein N_(ref) is the number of residues in one of thesequences. Hence, the DNA sequence AGTCAGTC will have a sequenceidentity of 75% with the sequence AATCAATC (N_(dif)=2 and N_(ref)=8).

The invention also pertains to compositions useful in exercising themethod of the invention. Hence, the invention also relates to animmunogenic composition comprising an immunogenically effective amountof an amyloidogenic polypeptide which is a self-protein in an animal,said amyloidogenic polypeptide being formulated together with animmunologically acceptable adjuvant so as to break the animal'sautotolerance towards the amyloidogenic polypeptide, the compositionfurther comprising a pharmaceutically and immunologically acceptablediluent and/or vehicle and/or carrier and/or excipient. In other words,this part of the invention pertains to the formulations of naturallyoccurring amyloidogenic polypeptides which have been described inconnection with embodiments of the method of the invention.

The invention also relates to an immunogenic composition comprising animmunologically effective amount of an analogue defined above, saidcomposition further comprising a pharmaceutically and immunologicallyacceptable diluent and/or vehicle and/or carrier and/or excipient andoptionally an adjuvant. In other words, this part of the inventionconcerns formulations of modified amyloidogenic polypeptide, essentiallyas described above. The choice of adjuvants, carriers, and vehicles isaccordingly in line with what has been discussed above when referring toformulation of modified and unmodified amyloidogenic polypeptide for usein the inventive method for the down-regulation of amyloid.

The polypeptides are prepared according to methods well-known in theart. Longer polypeptides are normally prepared by means of recombinantgene technology including introduction of a nucleic acid sequenceencoding the analogue into a suitable vector, transformation of asuitable host cell with the vector, expression by the host cell of thenucleic acid sequence, recovery of the expression product from the hostcells or their culture supernatant, and subsequent purification andoptional further modification, e.g. refolding or derivatization.

Shorter peptides are preferably prepared by means of the well-knowntechniques of solid- or liquid-phase peptide synthesis. However, recentadvances in this technology has rendered possible the production offull-length polypeptides and proteins by these means, and therefore itis also within the scope of the present invention to prepare the longconstructs by synthetic means.

Nucleic Acid Fragments and Vectors of the Invention

It will be appreciated from the above disclosure that modifiedamyloidogenic polypeptides can be prepared by means of recombinant genetechnology but also by means of chemical synthesis or semisynthesis; thelatter two options are especially relevant when the modificationconsists in coupling to protein carriers (such as KLH, diphtheriatoxoid, tetanus toxoid, and BSA) and non-proteinaceous molecules such ascarbohydrate polymers and of course also when the modification comprisesaddition of side chains or side groups to an amyloidogenicpolypeptide-derived peptide chain.

For the purpose of recombinant gene technology, and of course also forthe purpose of nucleic acid immunization, nucleic acid fragmentsencoding modified amyloidogenic polypeptide are important chemicalproducts. Hence, an important part of the invention pertains to anucleic acid fragment which encodes an analogue of an amyloidogenicpolypeptide, i.e. an amyloidogenic polypeptide-derived polypeptide whicheither comprises the natural sequence to which has been added orinserted a fusion partner or, preferably an amyloidogenicpolypeptide-derived polypeptide wherein has been introduced a foreignT-cell epitope by means of insertion and/or addition, preferably bymeans of substitution and/or deletion. The nucleic acid fragments of theinvention are either DNA or RNA fragments.

The nucleic acid fragments of the invention will normally be inserted insuitable vectors to form cloning or expression vectors carrying thenucleic acid fragments of the invention; such novel vectors are alsopart of the invention. Details concerning the construction of thesevectors of the invention will be discussed in context of transformedcells and microorganisms below. The vectors can, depending on purposeand type of application, be in the form of plasmids, phages, cosmids,mini-chromosomes, or virus, but also naked DNA which is only expressedtransiently in certain cells is an important vector. Preferred cloningand expression vectors of the invention are capable of autonomousreplication, thereby enabling high copy-numbers for the purposes ofhigh-level expression or high-level replication for subsequent cloning.

The general outline of a vector of the invention comprises the followingfeatures in the 5′→3′ direction and in operable linkage: a promoter fordriving expression of the nucleic acid fragment of the invention,optionally a nucleic acid sequence encoding a leader peptide enablingsecretion (to the extracellular phase or, where applicable, into theperiplasma) of or integration into the membrane of the polypeptidefragment, the nucleic acid fragment of the invention, and optionally anucleic acid sequence encoding a terminator. When operating withexpression vectors in producer strains or cell-lines it is for thepurposes of genetic stability of the transformed cell preferred that thevector when introduced into a host cell is integrated in the host cellgenome. In contrast, when working with vectors to be used for effectingin vivo expression in an animal (i.e. when using the vector in DNAvaccination) it is for security reasons preferred that the vector isincapable of being integrated in the host cell genome; typically, nakedDNA or non-integrating viral vectors are used, the choices of which arewell-known to the person skilled in the art

The vectors of the invention are used to transform host cells to producethe modified amyloidogenic polypeptide of the invention. Suchtransformed cells, which are also part of the invention, can be culturedcells or cell lines used for propagation of the nucleic acid fragmentsand vectors of the invention, or used for recombinant production of themodified amyloidogenic polypeptides of the invention. Alternatively, thetransformed cells can be suitable live vaccine strains wherein thenucleic acid fragment (one single or multiple copies) have been insertedso as to effect secretion or integration into the bacterial membrane orcell-wall of the modified amyloidogenic polypeptide.

Preferred transformed cells of the invention are microorganisms such asbacteria (such as the species Escherichia [e.g. E. coli], Bacillus [e.g.Bacillus subtilis], Salmonella, or Mycobacterium [preferablynon-pathogenic, e.g. M. bovis BCG]), yeasts (such as Saccharomycescerevisiae), and protozoans. Alternatively, the transformed cells arederived from a multicellular organism such as a fungus, an insect cell,a plant cell, or a mammalian cell. Most preferred are cells derived froma human being, cf. the discussion of cell lines and vectors below.Recent results have shown great promise in the use of a commerciallyavailable Drosophila melanogaster cell line (the Schneider 2 (S₂) cellline and vector system available from Invitrogen) for the recombinantproduction of polypeptides in applicants' lab, and therefore thisexpression system is particularly preferred.

For the purposes of cloning and/or optimized expression it is preferredthat the transformed cell is capable of replicating the nucleic acidfragment of the invention. Cells expressing the nucleic fragment arepreferred useful embodiments of the invention; they can be used forsmall-scale or large-scale preparation of the modified amyloidogenicpolypeptide or, in the case of non-pathogenic bacteria, as vaccineconstituents in a live vaccine.

When producing the modified molecules of the invention by means oftransformed cells, it is convenient, although far from essential, thatthe expression product is either exported out into the culture medium orcarried on the surface of the transformed cell.

When an effective producer cell has been identified it is preferred, onthe basis thereof, to establish a stable cell line which carries thevector of the invention and which expresses the nucleic acid fragmentencoding the modified amyloidogenic polypeptide. Preferably, this stablecell line secretes or carries the analogue of the invention, therebyfacilitating purification thereof.

In general, plasmid vectors containing replicon and control sequenceswhich are derived from species compatible with the host cell are used inconnection with the hosts. The vector ordinarily carries a replicationsite, as well as marking sequences which are capable of providingphenotypic selection in transformed cells. For example, E. coli istypically transformed using pBR322, a plasmid derived from an E. colispecies (see, e.g., Bolivar et al., 1977). The pBR322 plasmid containsgenes for ampicillin and tetracycline resistance and thus provides easymeans for identifying transformed cells. The pBR plasmid, or othermicrobial plasmid or phage must also contain, or be modified to contain,promoters which can be used by the prokaryotic microorganism forexpression.

Those promoters most commonly used in recombinant DNA constructioninclude the B-lactamase (penicillinase) and lactose promoter systems(Chang et al., 1978; Itakura et al., 1977; Goeddel et al., 1979) and atryptophan (trp) promoter system (Goeddel et al., 1979; EP-A-0 036 776).While these are the most commonly used, other microbial promoters havebeen discovered and utilized, and details concerning their nucleotidesequences have been published, enabling a skilled worker to ligate themfunctionally with plasmid vectors (Siebwenlist et al., 1980). Certaingenes from prokaryotes may be expressed efficiently in E. coli fromtheir own promoter sequences, precluding the need for addition ofanother promoter by artificial means.

In addition to prokaryotes, eukaryotic microbes, such as yeast culturesmay also be used, and here the promoter should be capable of drivingexpression. Saccharomyces cerevisiase, or common baker's yeast is themost commonly used among eukaryotic microorganisms, although a number ofother strains are commonly available. For expression in Saccharomyces,the plasmid YRp7, for example, is commonly used (Stinchcomb et al.,1979; Kingsman et al., 1979; Tschemper et al., 1980). This plasmidalready contains the trp1 gene which provides a selection marker for amutant strain of yeast lacking the ability to grow in tryptophan forexample ATCC No. 44076 or PEP4-1 (Jones, 1977). The presence of the trp1lesion as a characteristic of the yeast host cell genome then providesan effective environment for detecting transformation by growth in theabsence of tryptophan.

Suitable promoting sequences in yeast vectors include the promoters for3-phosphoglycerate kinase (Hitzman et al., 1980) or other glycolyticenzymes (Hess et al., 1968; Holland et al., 1978), such as enolase,glyceraldehyde-3-phosphate dehydrogenase, hexokinase, pyruvatedecarboxylase, phosphofructokinase, glucose-6-phosphate isomerase,3-phosphoglycerate mutase, pyruvate kinase, triosephosphate isomerase,phosphoglucose isomerase, and glucokinase. In constructing suitableexpression plasmids, the termination sequences associated with thesegenes are also ligated into the expression vector 3′ of the sequencedesired to be expressed to provide polyadenylation of the mRNA andtermination.

Other promoters, which have the additional advantage of transcriptioncontrolled by growth conditions are the promoter region for alcoholdehydrogenase 2, isocytochrome C, acid phosphatase, degradative enzymesassociated with nitrogen metabolism, and the aforementionedglyceraldehyde-3-phosphate dehydrogenase, and enzymes responsible formaltose and galactose utilization. Any plasmid vector containing ayeast-compatible promoter, origin of replication and terminationsequences is suitable.

In addition to microorganisms, cultures of cells derived frommulticellular organisms may also be used as hosts. In principle, anysuch cell culture is workable, whether from vertebrate or invertebrateculture. However, interest has been greatest in vertebrate cells, andpropagation of vertebrate in culture (tissue culture) has become aroutine procedure in recent years (Tissue Culture, 1973). Examples ofsuch useful host cell lines are VERO and HeLa cells, Chinese hamsterovary (CHO) cell lines, and W138, BHK, COS-7 293, Spodoptera frugiperda(SF) cells (commercially available as complete expression systems fromi.a. Protein Sciences, 1000 Research Parkway, Meriden, Conn. 06450,U.S.A. and from Invitrogen), and MDCK cell lines. In the presentinvention, an especially preferred cell line is S₂ available fromInvitrogen, PO Box 2312, 9704 CH Groningen, The Netherlands.

Expression vectors for such cells ordinarily include (if necessary) anorigin of replication, a promoter located in front of the gene to beexpressed, along with any necessary ribosome binding sites, RNA splicesites, polyadenylation site, and transcriptional terminator sequences.

For use in mammalian cells, the control functions on the expressionvectors are often provided by viral material. For example, commonly usedpromoters are derived from polyoma, Adenovirus 2, and most frequentlySimian Virus 40 (SV40). The early and late promoters of SV40 virus areparticularly useful because both are obtained easily from the virus as afragment which also contains the SV40 viral origin of replication (Fierset al., 1978). Smaller or larger SV40 fragments may also be used,provided there is included the approximately 250 bp sequence extendingfrom the HindIII site toward the BglI site located in the viral originof replication. Further, it is also possible, and often desirable, toutilize promoter or control sequences normally associated with thedesired gene sequence, provided such control sequences are compatiblewith the host cell systems.

An origin of replication may be provided either by construction of thevector to include an exogenous origin, such as may be derived from SV40or other viral (e.g., Polyoma, Adeno, VSV, BPV) or may be provided bythe host cell chromosomal replication mechanism. If the vector isintegrated into the host cell chromosome, the latter is oftensufficient.

Identification of Useful Analogues

It will be clear to the skilled person that not all possible variants ormodifications of naturally occurring amyloidogenic polypeptides willhave the ability to elicit antibodies in an animal which arecross-reactive with the natural form. It is, however, not difficult toset up an effective standard screen for modified amyloidogenic moleculeswhich fulfill the minimum requirements for immunological reactivitydiscussed herein. Hence, another part of the invention concerns a methodfor the identification of a modified amyloidogenic polypeptide which iscapable of inducing antibodies against unmodified amyloidogenicpolypeptide in an animal species where the unmodified amyloidogenicpolypeptide is a (non-immunogenic) self-protein, the method comprising

-   -   preparing, by means of peptide synthesis or genetic engineering        techniques, a set of mutually distinct modified amyloidogenic        polypeptides wherein amino acids have been added to, inserted        in, deleted from, or substituted into the amino acid sequence of        an amyloidogenic polypeptide of the animal species thereby        giving rise to amino acid sequences in the set which comprise        T-cell epitopes which are foreign to the animal species, or        preparing a set of nucleic acid fragments encoding the set of        mutually distinct modified amyloidogenic polypeptides,    -   testing members of the set of modified amyloidogenic        polypeptides or nucleic acid fragments for their ability to        induce production of antibodies by the animal species against        the unmodified amyloidogenic polypeptide, and    -   identifying and optionally isolating the member(s) of the set of        modified amyloidogenic polypeptides which significantly induces        antibody production against unmodified amyloidogenic polypeptide        in the species or identifying and optionally isolating the        polypeptide expression products encoded by members of the set of        nucleic acid fragments which significantly induces antibody        production against unmodified amyloidogenic polypeptide in the        animal species.

In this context, the “set of mutually distinct modified amyloidogenicpolypeptides” is a collection of non-identical modified amyloidogenicpolypeptides which have e.g. been selected on the basis of the criteriadiscussed above (e.g. in combination with studies of circular dichroism,NMR spectra, and/or X-ray diffraction patterns). The set may consist ofonly a few members but it is contemplated that the set may containseveral hundred members.

The test of members of the set can ultimately be performed in vivo, buta number of in vitro tests can be applied which narrow down the numberof modified molecules which will serve the purpose of the invention.

Since the goal of introducing the foreign T-cell epitopes is to supportthe B-cell response by T-cell help, a prerequisite is that T-cellproliferation is induced by the modified amyloidogenic polypeptide.T-cell proliferation can be tested by standardized proliferation assaysin vitro. In short, a sample enriched for T-cells is obtained from asubject and subsequently kept in culture. The cultured T-cells arecontacted with APCs of the subject which have previously taken up themodified molecule and processed it to present its T-cell epitopes. Theproliferation of T-cells is monitored and compared to a suitable control(e.g. T-cells in culture contacted with APCs which have processedintact, native amyloidogenic polypeptide). Alternatively, proliferationcan be measured by determining the concentration of relevant cytokinesreleased by the T-cells in response to their recognition of foreignT-cells.

Having rendered highly probable that at least one modified amyloidogenicpolypeptide of either type of set is capable of inducing antibodyproduction against amyloidogenic polypeptide, it is possible to preparean immunogenic composition comprising at least one modified amyloidpolypeptide which is capable of inducing antibodies against unmodifiedamyloidogenic polypeptide in an animal species where the unmodifiedamyloidogenic polypeptide is a self-protein, the method comprisingadmixing the member(s) of the set which significantly induces productionof antibodies in the animal species which are reactive with theamyloidogenic polypeptide with a pharmaceutically and immunologicallyacceptable carrier and/or vehicle and/or diluent and/or excipient,optionally in combination with at least one pharmaceutically andimmunologically acceptable adjuvant.

The above aspects of the invention pertaining to test of polypeptidesets are conveniently carried out by initially preparing a number ofmutually distinct nucleic acid sequences or vectors of the invention,inserting these into appropriate expression vectors, transformingsuitable host cells (or host animals) with the vectors, and effectingexpression of the nucleic acid sequences of the invention. These stepscan be followed by isolation of the expression products. It is preferredthat the nucleic acid sequences and/or vectors are prepared by methodscomprising exercise of a molecular amplification technique such as PCRor by means of nucleic acid synthesis.

Specific Amyloidogenic Targets

In addition to the proteins most often associated with Alzheimer's, APP,ApoE4 and Tau, there is long list of other proteins that have somehowbeen linked to AD, either by their direct presence in plaques or tanglesof AD brains or by their apparent genetic association with increasedrisk of developing AD. Most, if not all, of these antigens are togetherwith the above-discussed AD, APP, presenilin and ApoE4, putative targetproteins in the present invention.

Alpha1-antichymotrypsin (ACT) is a major component of SPs and issuggested to play an important role in the pathogenesis of the lesionsin AD and cerebrovascular amyloidosis (CA) (Acta neuropathol, 1998, 96:628-36). It interacts with Aβ in vitro and stimulates both formation anddisruption of Aβ-42 fibrils (JBC, 1998, 273: 28360-4).

Alpha2-macroglobulin was found by immunostaining in plaque cores in ADbrains. A transmembrane fragment from the beta-subunit was found inplaque cores, while the soluble alpha fragment was found extracellularlyin plaques. Acta neuropathol, 1998, 96: 628-36 and Brain Res., 1997,777: 223-227.

ABAD (Aβ-peptide binding alcohol dehydrogenase) binds with Aβ inside thecell. It is a neuronal enzyme present in normal cells but overexpressedin neurons affected by AD. Aβ is more toxic to cells that overexpressABAD. ABAD is linked to the X-chromosome. Yan, 1997, Nature 389.

APLP1 and -2 (amyloid precursor like protein 1 and -2): Both proteinsbelong to the APP homologue super-family proteins, but lack the Aβpeptide region. Nevertheless, there is a significant staining of APLP inneuritic plaques. Acta Neuropathol, 1997, 94: 519-524.

AMY117 is a newly discovered protein in plaque-like lesions in thebrains of people with AD which seems abundant, widespread, and “highlyspecific” for the disease. It is suspected that the protein, AMY117, mayplay a crucial role in the development and progression AD by formingthese plaques. Interestingly, AMY117 containing plaques do notco-localise with those containing Aβ, thus defining a new characteristicmanifestation of AD in addition to the well known Aβ containing plaquesand Tau containing tangles. AMY117-positive plaques were found to beabundant in the brains of sporadic cases of AD and in brains from peoplewith Down's syndrome, but “rare or absent” in brains of controls and ofother neurodegenerative diseases (Am J Pathol 1997; 151: 69, 80).

Bax: Monoclonal antibodies has detected Bax as a component of senileplaques in AD brains. Is also overexpressed in dystrophic neurites. ActaNeuropathol. 1998, 95: 407-412.

Bcl-2 has an unclear role. Overexpressed in glial cells surroundingplaques. Acta Neuropathol. 1998, 95: 407-412.

Bleomycin hydrolase is perhaps a beta-secretase. Anti bleomycinhydrolase immunoreactivity has been found in SP in AD (Brain Res. 1999,830: 200-202). A certain bleomycin hydrolase genotype has beenassociated with increased risk of developing AD in some cases, while inothers no correlation has been found (Ann Neurol, 1998, 44: 808-811 andAnn Neurol, 1999, 46: 136-137).

BRI/ABRI: ABRI is a 4 kD fragment of a putative transmembrane protein,encoded by the BRI gene on chromosome 13, found in amyloid plaques ofpeople with familial British dementia (FBD). These patients have amutation in the stop codon of the BRI gene that creates a longer openreading frame. Release of the 34 carboxy terminal amino acids of thealtered protein generates the ABRI amyloid subunit. Antibodies againstABRI recognise both parenchymal and vascular lesions in the brain of FBDpatients. The ABri peptide is deposited as amyloid fibrils and theresulting plaques are thought to lead to the neuronal dysfunction anddementia that characterizes FBD (Vidal, R et. al., 1999, Nature 399).

Chromogranin A has been detected in some diffuse amyloid deposits and indystrophic neurites surrounding these (Brain Res, 1991, 539: 143-50).

Clusterin/apoJ: This is a gene frequently isolated by differentialscreening in laboratories from different areas of molecular biology,since it is overexpressed in numerous cases of degenerative diseasessuch as AD and scrapie (Biochem J 1997 Nov. 15; 328(1):45-50 Michel D,Chatelain G, North S, Brun G).

CRF (corticotropin releasing factor) binding protein binds the 41 aa CRFpeptide that is an important regulatory factor in stress responses inthe brain. As most CRF is bound by CRF binding protein, removing CRFbinding protein (by immunotherapy) could lead to increased level of freeCRF, which is believed to have a positive effect against AD. Behan,1997, J. Neurochemistry, 68: 2053-2060.

EDTF (endothelial-derived toxic factor): A protein produced bymicrovessels from AD patients. Is specifically toxic to neuronal cells.WO 99/24468.

Heparan sulfate proteoglycans have been shown to co-localise with Aβ inSP's. Rat studies indicate that heparan sulfate glycosaminoglycan isrequired for amyloid fibre formation (Neuron, 1994, 12: 219-234 and Actaneuropathol, 1998, 96: 628-36).

Human collapsin response mediator protein-2 is 65 kDa protein recognisedin neurofibrillary tangles by a monoclonal antibody. Incorporation intotangles may deplete soluble protein and lead to abnormal neuriticoutgrowth, thus accelerating neuronal degeneration. JBC, 1998, 273:9761-8.

Huntingtin (Huntington's disease protein): In HD, the Huntingtin proteinis N-terminally expanded with polyglutamine. This form of Huntingtin isalso found in NFT's in AD brains and in Pick's disease (Exp. Neurol,1998, 150: 213-222).

ICAM-1 is accumulated in SP's. Acta neuropathol, 1998, 96: 628-36 andAm. J Pathol. 1994, 144: 104-16.

IL-6 is associated with neurofibrillar changes and is found in thecentre of plaques. Has been proposes to be a triggering event in AD. Isstrongly amplified in astrocytes by the active peptide 25-35 of Aβ.Brain Res., 1997, 777: 223-227 and Behav Brain Res, 1996, 78: 37-41.

Lysosome-associated antigen CD68 is recognised by antibody KP-1 in NFT'sand SP's. Thus, lysosomes may play a role in the formation of tanglesand plaques. Dement Geriatr Cogn Disord, 1998, 9: 13-19.

P21 ras is involved as a primary step in the elevation of growth factorsand mitogens seen at early stages of AD development. Neuroscience, 1999,91: 1-5.

PLC-delta 1 (phospholipase C isoenzyme delta 1) is abnormallyaccumulated in NFT's and neurites surrounding plaque cores. Isintracellular. Alzheimer Dis Assoc Disord, 1995, 9: 15-22.

Serum amyloid P component (SAP) is a normal plasma constituent that ispresent in all types of amyloid deposits, including that of AD (JBC,1995, 270: 26041-4). It is observed in both SP's and NFT's. In somestudies it was shown to promote Aβ aggregation and to preventproteolysis of fibrils (Biochem Biophys Res commun, 1995, 211: 349v-53and PNAS, 1995, 92: 4299-4303) while another study indicates that SAPinhibit Aβ fibril formation (JBC, 1995, 270: 26041-4).

Synaptophysin has been detected in some diffuse amyloid deposits and indystrophic neurites surrounding these. (Brain Res, 1991, 539: 143-50).

Synuclein (alpha-synuclein or NACP): The non-A beta component of ADamyloid (NAC) was identified biochemically as the second major componentin the amyloid purified from brain tissue of AD patients. NAC, derivedfrom its 140 amino acid long precursor, NACP, is at least 35 amino acidslong (NAC35) although its amino terminus is not definitely determined.An NAC monoclonal antibody immunostains SP's in AD brains, but does notreact with NACP (Biochemistry 34 (32): 10139-10145 (Aug. 15, 1995) IwaiA, Yoshimoto M, Masliah E, Saitoh T). NAC self-oligomers in the presenceof Aβ. New evidence points to a potential role for this molecule insynaptic damage and neurotoxicity via amyloid-like fibril formation andmitochondrial dysfunction. Brain Pathol 1999 October; 9(4):707-20. FEBSLett, 1998, 421:73-76. A part of NACP has high homology to theC-terminal amyloid fragment of APP and to a region of scrapie prionprotein (PrPSc). Synuclein is a major causative factor of Parkinson's(Chem Biol, 1995, 2: 163-9).

TGF-b1 (transforming growth factor b1): Overexpression of TGF-b1 withmutant APP in TG mice accelerates deposition of Aβ. Thus, TGF-b1 isbelieved to be involved in initiating or promoting amyloid plaqueformation (Wyss-Coray, 1997, Nature 389).

Other Amyloidic Diseases and Proteins Associated Therewith

In addition to the above mentioned proteins that are potentiallyinvolved in AD and AD like diseases (Huntington's, Parkinson's, FBD andother forms of dementia), there are a relatively large number ofdiseases other than AD where amyloid formation is involved in triggeringthe disease or in causing the symptoms of the disease. Although theproteins involved in these diseases vary in nature they share the samefeatures which define amyloid, cf. above. The following table lists anumber of these amyloidic disorders and the proteins causing them.

Diversity of amyloid fibril proteins Precursor Clinical Syndrome Fibrilsubunit structure Cerebral amyloid angiopathy Aβ All β (CAA) Monoclonalprotein systemic Full length or fragments of V All β (AL) amyloidosisdomain of IG light chain Reactive systemic (AA) 76-residue N-terminalfragment α/β amyloidosis of amyloid A protein Familial amyloidoticFull-length or fragments of All β polyneuropathy transthyretin variantsHereditary ApoA1 amyloidosis N-terminal fragments (~90 resi- (α/β) dues)of ApoA1 variants Hereditary lysozyme amyloid- Full-length lysozymevariants α + β osis Type II diabetes mellitus 37-residue fragment ofislet- Unknown amyloid polypeptide Insulin-related amyloid Full-lengthwild-type insulin α + β Transmissible spongioform Full-length orfragments of α + β encephalopathis prion protein Medullary carcinoma ofthe Fragments of calcitonin Unknown thyroid Senile systemic amyloidosisFull-length or fragments of All β transthyretin Hemodialysis-relatedamyloid- Full-length, wild-type β-2 All β osis microglobulin Isolatedatrial amyloidosis Atrial natriuretic factor Unknown Hereditary cerebralamyloid 110-residue fragment of variant α + β angiopathy cystatinFinnish hereditary amyloidosis 71-residue fragment of gelsolin α/βvariants Hereditary fibrinogen a-chain Fragments of fibrinogen a-chainUnknown amyloidosis variants

These proteins are, like the proteins involved in AD, all potentialtargets for the immunization strategy suggested herein.

It is contemplated that most methods for immunizing againstamyloidogenic polypeptides should be restricted to immunization givingrise to antibodies cross-reactive with the native amyloidogenicpolypeptide. Nevertheless, in some cases it will be of interest toinduce cellular immunity in the form of CTL responses against cellswhich present MHC Class I epitopes from the amyloidogenicpolypeptides—this can be expedient in those cases wherein reduction inthe number of cells producing the amyloidogenic polypeptides does notconstitute a serious adverse effect. In such cases where CTL responsesare desired it is preferred to utilise the teachings of Applicant'sPCT/DK99/00525 (corresponding to U.S. Ser. No. 09/413,186). Thedisclosures of these two documents are hereby incorporated by referenceherein.

In the following non-limiting example, focus has been put on thedevelopment of a Aβ based autovaccine against AD. However, theprinciples set forth herein apply equally to any amyloid protein.

EXAMPLE 1 The Auto Vaccination Approach for Immunizing Against AD

The fact that Aβ protein knock out mice does not show any abnormalitiesor adverse side effects, suggest that removal or lowering the amounts ofAβ will be safe, Zheng H. (1996).

Published experiments where transgenic animals are immunized against thetransgenic human Aβ protein suggest that if it was possible to break theself tolerance, down-regulation of Aβ could be obtained by auto-reactiveantibodies. These experiments further suggest that such down regulationof Aβ potentially would both prevent the formation of plaques, and evenclear already formed Aβ plaques from the brain, of Schenk et al. (1999).But, traditionally it is not possible to raise antibodies againstself-proteins.

The published data does thus not provide the means for breaking trueself-tolerance towards true self-proteins. Nor does the data provideinformation on how to ensure that the immune reaction is directed solelyor predominantly towards the Aβ deposits, and not towards the cellmembrane bound Aβ precursor protein (APP), if this is deemed necessary.An immune response generated using the existing technology wouldpresumably generate an immune response towards self-proteins in anunregulated way so unwanted and excessive auto-reactivity towards partsthe Aβ protein may be generated. Hence, using existing immunizationstrategies will most likely be unable to generate strong immuneresponses towards self-proteins and will furthermore be unsafe due topotential strong cross-reactivity towards membrane bound APP which ispresent on a large number of cells in the CNS.

The present invention provides the means of effectively generating astrong regulated immune response towards true self-proteins whichpotentially could form plaques and cause serious disease in the CNS orin other compartments of the body. A safe and efficacious human Aβprotein therapeutic vaccine will be developed by using this technologyfor the treatment of AD.

In light of this, it is possible to anticipate that AD, a diseasepredicted to cripple the health care system in the next century, couldbe cured, or such vaccines described could at least constitute aneffective therapeutical approach for treatment of the symptoms andprogression of this disease.

This technique represents a entirely new immunological approach toblocking amyloid deposition in AD and other neurologic diseases as well.

In the following table, 35 contemplated constructs are indicated. Allpositions given in the table are relative to the starting Methionine ofAPP (first amino acid in SEQ ID NO: 2) and include both the starting andending amino acid, e.g. the 672-714 fragment includes both amino acid672 and 714. The starting and ending positions for P2 and P30 indicatethat the epitope substitutes a part of the APP fragment at the positionsindicated (both positions included in the substitution)—in mostconstructs, the introduced epitopes substitutes a fragment of the lengthof the epitope. The asterisks in the table have the following meaning:

-   *) Only one position for P2 and P30 indicates that the epitope has    been inserted into the APP derivative at the position indicated (the    epitope begins at the amino acid C-terminally adjacent to the given    position).-   **) Construction 34 contains three identical APP fragments separated    by P30 and P2, respectively.-   ***) Construction 35 contains nine identical APP fragments separated    by alternating P30 and P2 epitopes.

APP AutoVac constructions Var. Start of APP segment End of APP segmentPosition of P2 epitope Position of P30 epitope Molecule No. relative toaa 1 of APP relative to aa 1 of APP relative to aa 1 of APP relative toaa 1 of APP length 1 630 770 656-670 635-655 141 2 630 714 656-670635-655 85 3 672 770 735-749 714-728 99 4 672 770 714-728 99 5 672 770714-728 99 6 672 770 723* 723* 135 7 672 770 723* 120 8 672 770 723* 1149 672 714 672* 64 10 672 714 714* 64 11 672 714 672* 58 12 672 714 714*58 13 672 714 714* 672* 79 14 672 714 680-694 43 14 672 714 685-799 4316 672 714 690-704 43 17 672 714 695-709 43 18 672 714 675-695 43 19 672714 680-700 43 20 672 714 685-705 43 21 672 714 690-710 43 22 672 714680* 680* 79 23 672 714 690* 690* 79 24 672 714 700* 700* 79 25 672 714710* 710* 79 26 672 714 680* 64 27 672 714 690* 64 28 672 714 700* 64 29672 714 710* 64 30 672 714 680* 58 31 672 714 690* 58 32 672 714 700* 5833 672 714 710* 58 34 672 714 After rep. 1** After rep. 2** 165 35 672714 34 × 3* 34 × 3*** 165

The part of APP against which it most interesting to generate a responseis the 43 amino acid Aβ core peptide (Aβ-43, corresponding to SEQ ID NO:2, residues 672-714) that is the main constituent of amyloid plaques inAD brains. This APP fragment is part of all constructions listed above.

Variants 1 and 2 comprise a portion of APP upstream of Aβ-43 where themodel epitopes P2 and P30 have been placed. Variants 1 and 3˜8 allcomprise the C-100 fragment which has been shown to be neurotoxic—theC-100 fragment corresponds to amino acid residues 714-770 of SEQ ID NO:2. In variants 3-5 the epitopes substitutes a part of the C-100 fragmentwhile the in variants 6-8 have been inserted into C-100.

Variants 9-35 contain only the core Aβ-43 protein. In variants 9-13, P2and P30 are fused to either end of Aβ-43; in 14-21 P2 and P30substitutes part of Aβ-43; in 22-33 P2 and P30 are inserted into Aβ-43;34 contains three identical Aβ-43 fragments spaced by P30 and P2,respectively; 35 contains 9 Aβ-43 repeats spaced by alternating P2 andP30 epitopes.

See FIG. 1 and the table above for details.

One further type of construct is especially preferred. Since one goal ofthe present invention is to avoid destruction of the cells producing APPwhereas removal of Aβ is desired, it seems feasible to prepareautovaccine constructs comprising only parts of Aβ which are not exposedto the extracellular phase when present in APP. Thus, such constructswould need to contain at least one B-cell epitope derived from the aminoacid fragment defined by amino acids 700-714 in SEQ ID NO: 2.

Since such a short polypeptide fragment is predicted to be only weaklyimmunogenic it is preferred that such an autovaccine construct consistsof several copies of the B-cell epitope, e.g. in the form of a constructhaving the structure shown in Formula I in the detailed disclosure ofthe present invention, cf. above. In that version of Formula I, theterms amyloid_(e1)-amyloid_(ex) are x B-cell epitope containing aminoacid sequences derived from amino acids 700-714 of SEQ ID NO: 2. Apreferred alternative is the above-detailed possibility of coupling theamyloidogenic (poly)peptide and the selected foreign T-helper epitope tovia an amide bond to a polysaccharide carrier molecule—in this waymultiple presentations of the “weak” epitope constituted by amino acids700-714 of SEQ ID NO: 2 become possible, and it also becomes possible toselect an optimum ratio between B-cell and T-cell epitopes.

EXAMPLE 2 Immunisation of Transgenic Mice with Aβ and Modified ProteinsAccording to the Invention

Construction of the hAB43+−34 encoding DNA. The hAB43+−34 gene wasconstructed in several steps. First a PCR fragment was generated withprimers ME#801 (SEQ ID NO: 10) and ME#802 (SEQ ID NO: 11) using primerME#800 (SEQ ID NO: 9) as template. ME#800 encodes the human abeta-43fragment with E. coli optimised codons. ME#801 and 802 adds appropriaterestriction sites to the fragment.

The PCR fragment was purified, digested with NcoI and HindIII, purifiedagain and cloned into NcoI-HindIII digested and purified pET28b+ E. coliexpression vector. The resulting plasmid encoding wildtype human Aβ-43is named pAB1.

In the next step the T-helper epitope, P2, is added to the C-terminus ofthe molecule. Primer ME#806 (SEQ ID NO: 12) contains the sequenceencoding the P2 epitope, thus generating a fusion of P2 and Abeta-43 bythe PCR reaction.

The cloning was performed by making a PCR fragment with primers ME#178(SEQ ID NO: 8) and ME#806 using pAB1 as template. The fragment waspurified, digested with NcoI and HindIII, purified again and cloned intoan NcoI-HindIII digested and purified pET2Sb+ vector. The resultingplasmid is called pAB2.

In an analogous manner, another plasmid was made harbouring the Aβ-43encoding sequence with another T helper epitope, P30, added to theN-terminus. This was done by making a PCR fragment with primers ME#105(SEQ ID NO: 7) and ME#807 (SEQ ID NO: 13) using pAB1 as template.

The fragment was purified, digested with NcoI and HindIII, purifiedagain and cloned into an NcoI-HindIII digested and purified pET28b+vector. The resulting plasmid is called pAB3.

In the third step, a second Aβ-43 repeat is added C-terminally to the P2epitope of plasmid pAB2 by primer ME#809 (SEQ ID NO: 14). ME#809 at thesame time creates a BamHI site immediately after the Aβ-43 repeat. A PCRfragment was made with primers ME#178 and ME#809 using pAB2 as template.The fragment was digested with NcoI and HindIII, purified and clonedinto NcoI-HindIII digested and purified pET28b+ vector. This plasmid isnamed pAB4.

Finally, the P30 epitope—Aβ-43 repeat sequence from pAB3 was cloned intopAB4 plasmid. This was done by making a PCR fragment with primers ME#811(SEQ ID NO: 16) and ME#105 using pAB3 as template. The fragment waspurified and used as primer in a subsequent PCR with ME#810 (SEQ ID NO:15) using pAB3 as template. The resulting fragment was purified,digested with BamHI and HindIII and cloned into BamHI-HindIII digestedand purified pAB4 plasmid. The resulting plasmid, pAB5, encodes thehAB43+−34 molecule.

All PCR and cloning procedures were done essentially as described bySambrook, J., Fritsch, E. F. & Maniatis, T. 1989 “Molecular cloning: alaboratory manual”. 2nd. Ed. Cold Spring Harbor Laboratory, N.Y.

For all cloning procedures E. coli K-12 cells, strain Top-10 F′(Stratagene, USA), were used. The pET28b+ vector was purchased fromNovagen, USA. All primers were synthesised at DNA Technology, Denmark.

Expression and purification of hAB43+−34. The hAB43+−34 protein encodedby pAB5 was expressed in BL21-Gold (Novagen) E. coli cells as describedby the suppliers of the pET28b+ system (Novagen).

The expressed hAB43+−34 protein was purified to more than 85% purity bywashing of inclusion bodies followed by cation-exchange chromatographyusing a BioCad purification workstation (PerSeptive Biosystems, USA) inthe presence of 6 M urea. The urea was hereafter removed by stepwisedialysis against a solution containing decreasing amounts of urea. Thefinal buffer was 10 mM Tris, pH 8.5.

Immunisation study. Mice transgenic for human APP (Alzheimer's precursorprotein) were used for the study. These mice, called TgRND8+, express amutated form of APP that results in high concentration of Aβ-40 andAβ-42 in the mouse brains (Janus, C. et. al.)

The mice (8-10 mice per group) were immunised with either Abeta-42 (SEQID NO: 2, residues 673-714, synthesised by means of a standard Fmocstrategy) or the hAB43+−34 variant (construct 34 in the table in Example1, recombinantly produced) four times at two-week intervals. Doses wereeither 100 mg for Aβ or 50 mg for hAB43+−34. Mice were bled at day 43(after three injections) and after day 52 (after four injections) andthe sera were used to determine the level of anti-Aβ-42 specific titresusing a direct Aβ-42 ELISA.

The following table shows the mean relative anti-Abeta-42 titres.

Day 43 Day 52 Immunogen (after 3 immunizations) (after 4 immunizations)Aβ-42 4000 3000 hAB43+-34 16000 23000

As will be clear, the antibody titers obtained when immunizing with thehAB43+−34 Aβ variant are approximately 4 times and 7.5 times higherafter 3 and 4 immunizations, respectively, than the titers obtained whenusing the unaltered wild-type Aβ-42 as an immunogen. This fact is putfurther in perspective, when considering the fact that the amount ofvariant used for immunization was only 50% of the amount of wild-typesequence used for immunization.

EXAMPLE 3 Synthesis of an Aβ Peptide Copolymer Vaccine Using ActivatedPoly-Hydroxypolymer as the Cross-Linking Agent

Introduction. A traditional conjugate vaccine consists of a(poly)peptide coupled covalently to a carrier protein. The peptidecontains the B-cell epitope(s) and the carrier protein provides T-helperepitopes. However, most of the carrier protein will normally beirrelevant as a source for T-helper epitopes, since only a minor part ofthe total sequence contains the relevant T-helper epitopes. Suchepitopes can be defined and synthesized as peptides of e.g. 12-15 aminoacids. If these peptides are linked covalently to peptides containingthe B-cell epitopes, e.g. via a multivalent activatedpolyhydroxypolymer, a vaccine molecule that only contains the relevantparts can be obtained. It is further possible to provide a vaccineconjugate that contains an optimized ratio between B-cell and T-cellepitopes.

Synthesis of the acticated poly-hydroxypolymer. Polyhydroxypolymers suchas dextran, starch, agarose etc. can be activated with2,2,2-trifluoroethanesulfonyl chloride (tresyl chloride), either bymeans of a homogenous synthesis (dextran) dissolved inN-methylpyrrolidinone (NMP) or by means of a heterogeneous synthesis(starch, agarose, cross-linked dextran) in e.g. acetone.

225 ml dry N-methylpyrrolidinone (NMP) is added under dry conditions tofreeze dried, water-soluble dextran (4.5 g, 83 mmol, clinical grade, Mw(avg) 78000) in a 500 ml round bottom flask supplied with a magnet forstirring. The flask is placed in a 60° C. oil bath with magneticstirring. The temperature is raised to 92° C. over a period of 20 min.When the dextran is dissolved the flask is immediately removed from theoil bath and the temperature in the bath is lowered to 40° C. The flaskis placed into the oil bath agaom, still with magnetic stirring, andtresyl chloride (2.764 ml, 25 mmol) is added drop-wise. After 15 min,dry pyridine (anhydrous, 2.020 ml, 25 mmol) is added drop-wise. Theflask is removed from the oil bath and stirred for 1 hour at roomtemperature. The product (Tresyl Activated Dextran, TAD) is precipitatedin 1200 ml cold ethanol (99.9%). The supernatant is decanted and theprecipitate is harvested in 50 ml polypropylene tubes in a centrifuge at2000 rpm. The precipitate is dissolved in 50 ml 0.5% acetic acid,dialyzed 2 times against 5000 ml 0.5% acetic acid and freeze dried. TADcan be stored as a freeze dried powder at −20° C.

An insoluble poly-hydroxypolymer, such as agarose or cross-linkeddextran can be tresyl activated by making a suspension of thepoly-hydroxypolymer in e.g. acetone and perform the synthesis as a solidphase synthesis. The activated poly-hydroxypolymer can be harvested byfiltration. Suitable methods are reported in e.g. Nilsson K and MosbachK (1987), Methods in Enzymology 135, p. 67, and in Hermansson G T et al.(1992), in “Immobilized Affinity Ligand Techniques”, Academic Press,Inc., p. 87.

Synthesis of the A Beta Peptide Copolymers Vaccines. TAD (10 mg) isdissolved in 100 μl H₂O and 1000 μl carbonate buffer, pH 9.6, containing5 mg Aβ-42 (SEQ ID NO: 2, residues 673-714), 2.5 mg P2 (SEQ ID NO: 4)and 2.5 mg P30 (SEQ ID NO: 6) is added. The Aβ-42 and the P2 and P30peptides all contain protected lysine groups: these are in the form of1-(4,4-Dimethyl-2,6-dioxocyclohex-1-ylidene)ethyl (Dde) protected lysinegroups. The peptides are prepared by means of a standard Fmoc strategy,where the conventional Fmoc-Lys (Boc)-OH has been substituted withFmoc-Lys(Dde)-OH (obtained from Novabiochem, cat. no. 04-12-1121), i.e.the ε-amino group in lysine is protected with Dde instead of Boc.

The pH value is measured and adjusted to 9.6 using 1 M HCl. After 2.5hours at room temperature, hydrazine from an 80% solution is added to afinal hydrazine Concentration of 8% and the solution is incubated foranother 30 min. at room temperature and freeze-dried immediatelyhereafter. The freeze-dried product is dissolved in H₂O and dialysedextensively against H₂O before the final freeze-drying.

The ratio between B-cell epitopes (Aβ) and T-helper epitopes (P2 andP30) in the final product can be varied by using differentconcentrations of these peptides in the synthesis step. Furthermore, thefinal product can be tagged with e.g. mannose (so as to target theconjugate to APCs) by adding aminated mannose to the carbonate buffer inthe synthesis step.

If an insoluble activated poly-hydroxypolymer is used to combine thepeptides containing the B-cell epitope and the T-helper epitopes, thecoupling to the polymer can be performed as a solid phase synthesis andthe final product is harvested and purified by wash and filtration.

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1. A method for in vivo down-regulation of autologous beta amyloid (Aβ)protein or autologous amyloid precursor protein (APP) in an animal,including a human being, the method comprising effecting presentation tothe animal's immune system of an immunogenically effective amount of atleast one analogue of the animal's autologous Aβ or autologous APPwherein is introduced at least one isolated foreign T helper epitope(T_(H) epitope) by means of insertion, addition, deletion, orsubstitution, or by means of separate coupling to a polyhydroxypolymercarrier backbone of the T_(H) epitope and an Aβ or APP derived peptidesequence, so that immunization of the animal with the analogue inducesproduction of antibodies against the autologous Aβ or autologous APP inthe animal, wherein the foreign T_(H) epitope is introduced into Aβ orAPP as schematically shown for the P2 and P30 epitopes in FIG. 1, orwherein the foreign T_(H) epitope is coupled to a polyhydroxypolymercarrier backbone that also carries an Aβ or APP derived peptidesequence.
 2. The method according to claim 1, wherein the introductionhas as a result that a substantial fraction of B-cell epitopes of Aβ orAPP are preserved and that at least one first moiety is introduced whicheffects targeting of the analogue to an antigen presenting cell (APC) ora B-lymphocyte, and/or at least one second moiety is introduced whichstimulates the immune system, and/or at least one third moiety isintroduced which optimizes presentation of the analogue to the immunesystem.
 3. The method according to claim 2, wherein the analogue ismodified by introduction as side groups, by covalent or non-covalentbinding to suitable chemical groups in the Aβ, APP, or a subsequencethereof, of the first and/or of the second and/or of the third moiety.4. The method according to claim 1, wherein introduction of the aminoacid substitution and/or deletion and/or insertion and/or additionresults in a substantial preservation of the overall tertiary structureof the autologous Aβ or autologous APP.
 5. The method according to claim1, wherein the analogue includes a duplication of at least one B-cellepitope of the autologous Aβ or autologous APP and/or an introduction ofa hapten.
 6. The method according to claim 1, wherein the foreign T-cellepitope is immunodominant in the animal.
 7. The method according toclaim 1, wherein the foreign T-cell epitope is promiscuous.
 8. Themethod according to claim 7, wherein the T-cell epitope is selected froma Tetanus toxoid epitope, a diphtheria toxoid epitope, an influenzavirus hemaglutinin epitope, and a P. falciparum CS epitope.
 9. Themethod according to claim 2, wherein the first moiety is a substantiallyspecific binding partner for a B-lymphocyte specific surface antigen orfor an APC specific surface antigen.
 10. The method according to claim2, wherein the second moiety is selected from a cytokine a hormone; anda heat-shock protein.
 11. The method according to claim 2, wherein thethird moiety is of lipid nature or a polyhydroxypolymer.
 12. The methodaccording to claim 11, wherein the polysaccharide serves as a carrierbackbone to which the Aβ or APP derived peptide and the foreign T cellepitope are separately bound.
 13. The method according to claim 12,wherein the Aβ or APP derived peptide and the foreign T cell epitope arebound via an amide bond to the polysaccharide.
 14. The method accordingto claim 1, wherein the autologous Aβ or APP has been modified so as topreserve B-cell epitopes which are not exposed to the extracellularphase when present in a cell-bound form of the autologous APP.
 15. Themethod according to claim 14, wherein the autologous Aβ or autologousAPP has been modified so as to lack at least one B-cell epitope which isexposed to the extracellular phase when present in a cell-bound form ofthe autologous APP.
 16. The method according to claim 1 which comprisesa substitution of at least one amino acid sequence within autologous Aβor APP with an amino acid sequence of equal or different length whichgives rise to a foreign T_(H) epitope in the analogue.
 17. The methodaccording to claim 1, wherein the analogue comprises the amino acidsequence corresponding to amino acids 672-714 in SEQ ID NO: 2, whereinis inserted an amino acid sequence which gives rise to a foreign T_(H)epitope in the analogue, or wherein the analogue comprises an amino acidsequence corresponding to amino acids 672-714 of SEQ ID NO: 2, whereinat least one amino acid sequence is substituted by an amino acidsequence of equal or different length so as to give rise to a foreignT_(H) epitope.
 18. The method according to claim 1, wherein presentationto the immune system is effected by having at least two copies of theanalogue covalently of non-covalently linked to a carrier moleculecapable of effecting presentation of multiple copies of antigenicdeterminants.
 19. The method according to claim 1, wherein the analoguehas been formulated with an adjuvant which facilitates breaking ofautotolerance to autoantigens.
 20. The method according to claim 1,wherein an effective amount of the analogue is administered to theanimal via a route selected from the parenteral route, the subcutaneous,and the intramuscular routes; the peritoneal route; the oral route; thebuccal route; the sublingual route; the epidural route; the spinalroute; the anal route; and the intracranial route.
 21. The methodaccording to claim 20, wherein the effective amount is between 0.5 μgand 2,000 μg of the analogue.
 22. The method according to claim 20,wherein the analogue is contained in a virtual lymph node (VLN) device.23. The method according to claim 1, wherein presentation of modifiedautologous Aβ or autologous APP to the immune system is effected byintroducing nucleic acid(s) encoding the analogue into the animal'scells and thereby obtaining in vivo expression by the cells of thenucleic acid(s) introduced.
 24. The method according to claim 23,wherein the nucleic acid(s) introduced is/are selected from naked DNA,DNA formulated with charged or uncharged lipids, DNA formulated inliposomes, DNA included in a viral vector, DNA formulated with atransfection-facilitating protein or polypeptide, DNA formulated with atargeting protein or polypeptide, DNA formulated with Calciumprecipitating agents, DNA coupled to an inert carrier molecule, DNAencapsulated in chitin or chitosan, and DNA formulated with an adjuvant.25. The method according to claim 24, wherein the nucleic acid(s) is/arecontained in a VLN device.
 26. The method according to claim 20 whichincludes at least one administration/introduction per year.
 27. A methodfor treating and/or preventing and/or ameliorating Alzheimer's diseaseor other diseases and conditions characterized by Aβ deposits, themethod comprising down-regulating autologous Aβ or APP according to themethod of claim 1 to such an extent that the total amount of amyloid isdecreased or that the rate of amyloid formation is reduced with clinicalsignificance.
 28. An analogue of an autologous Aβ or autologous APPwhich is derived from an animal Aβ or APP wherein is introduced at leastone isolated foreign T_(H) epitope as schematically shown for the P2 andP30 epitopes in FIG. 1, or wherein at least one foreign T_(H) epitope iscoupled to a polyhydroxypolymer carrier backbone that also carries an Aβor APP derived peptide sequence so that immunization of the animal withthe analogue induces production of antibodies against the autologous Aβor autologous APP.
 29. An analogue according to claim 28, wherein themodification is as defined in claim
 2. 30. An immunogenic compositioncomprising an immunogenically effective amount of an analogue accordingto claim 28, the composition further comprising a pharmaceutically andimmunologically acceptable carrier and/or vehicle and optionally anadjuvant.
 31. A nucleic acid fragment which encodes an analogueaccording to claim
 28. 32. A vector carrying the nucleic acid fragmentaccording to claim
 31. 33. The vector according to claim 32 which isselected from the group consisting of a plasmid, a phage, a cosmid, amini-chromosome, and a virus.
 34. The vector according to claim 32comprising, in the 5′→3′ direction and in operable linkage, a promoterfor driving expression of the nucleic acid fragment, optionally anucleic acid sequence encoding a leader peptide enabling secretion of orintegration into the membrane of the polypeptide fragment, the nucleicacid fragment according to claim 31, and optionally a terminator. 35.The vector according to claim 32 which, when introduced into a hostcell, is capable or incapable of being integrated in the host cellgenome.
 36. The vector according to claim 34, wherein a promoter drivesexpression in a eukaryotic cell and/or in a prokaryotic cell.
 37. Atransformed cell carrying the vector of claim 32, such as a transformedcell which is capable of replicating the nucleic acid fragment.
 38. Thetransformed cell according to claim 37, which is a microorganismselected from a bacterium, a yeast, a protozoan, or a cell derived froma multicellular organism selected from a fungus, an insect cell, a plantcell, and a mammalian cell.
 39. The transformed cell according to claim37, which expresses the nucleic acid fragment according to claim
 31. 40.The method according to claim 1, wherein presentation to the immunesystem is effected by administering a non-pathogenic microorganism orvirus which is carrying a nucleic acid fragment which encodes andexpresses the analogue.
 41. A composition for inducing production ofantibodies against Aβ or APP, the composition comprising a nucleic acidfragment according to claim 31 or a vector according to claim 32, and apharmaceutically and immunologically acceptable carrier and/or vehicleand/or adjuvant.
 42. A stable cell line which carries the vectoraccording to claim 32 and which expresses the nucleic acid fragment, andwhich optionally secretes or carries the analogue according to claim 28on its surface.
 43. A method for the preparation of the cell accordingto claim 37, the method comprising transforming a host cell with thenucleic acid fragment according to claim 31 or with the vector accordingto claim
 32. 44. A method for treating an animal by down-regulatingamyloid which comprises administering an effective amount of an analogueaccording to claim
 28. 45. A method for the treatment, prophylaxis oramelioration of Alzheimer's disease or other conditions characterized byamyloid deposits which comprises administering to a patient an effectiveamount of an analogue according to claim
 28. 46. The method according toclaim 7, wherein said T-cell epitope is a foreign T-cell epitope whichis selected from a natural promiscuous T-cell epitope and an artificialMHC-II binding peptide sequence.
 47. The method according to claim 28,wherein said Tetanus toxiod epitope is P₂ or P₃₀.
 48. The methodaccording to claim 9, wherein the first moiety is a hapten or acarbohydrate for which there is a receptor on the B-lymphocyte or theAPC.
 49. The method according to claim 1, wherein said cytokine is amember selected from the groups consisting of interferon γ (IFN-γ) or aneffective part thereof, Flt3L or an effective part thereof, interleukin1 (IL-1) or an effective part thereof, interleukin 2 (IL-2) or aneffective part thereof, interleukin 4 (IL-4) or an effective partthereof, interleukin 6 (IL-6) or an effective part thereof, interleukin12 (IL-12) or an effective part thereof, interleukin 13 (IL-13) or aneffective part thereof, interleukin 15 (IL-15) or an effective partthereof, and granulocyte-macrophage colony stimulating factor (GM-CSF)or an effective part thereof; and granulocyte-macrophage colonystimulating factor (GM-CSF) or an effective part thereof; and said heatstock protein is a member selected from the group consisting of HSP70 oran effective part thereof such as HSP70 or an effective part thereof,HSP90 or an effective part thereof, HSC70 or an effective part thereof,GRP94 or an effective part thereof, and calreticulin (CRT) or aneffective part thereof.
 50. The method according to claim 11, whereinsaid third moiety of a liquid nature is a member selected from the groupconsisting of a palmitoyl group, a myristyl group, a farnesyl group, ageranyl-geranyl group, a GPI-anchor, and an N-acyl diglyceride group andsaid polyhydroxy polymer is a polysaccharide.
 51. The method accordingto claims 20, wherein the parenteral route is intracutaneous.
 52. Themethod according to claim 26, which comprises at least 2, 3, 4, 6 or 12administrations/introduction per year.
 53. The method according to claim32, which is capable of autonomous replication.
 54. The transformed cellaccording to claim 37, which is a transformed cell which is capable ofreplicating the nucleic acid fragment.
 55. The transformed cellaccording to claim 38, wherein said insect cell is an S₂ or an SF cell.56. The transformed cell according to claim 37, wherein the transformedcell secretes or carries on its surface the analogue according to claim28.
 57. The analogue according to claim 28, wherein said T_(H) epitopeis at least one member selected from the group consisting of tetanustoxoid P20, tetanus toxoid P30, diphtheria toxoid, hemaglutinin, P.falciparum CS antigen, artificial MHC-II binding peptide sequence andPADRE.
 58. The analogue according to claim 29, wherein said firstmolecule is at least one member selected from the group consisting of acarbohydrate for which there is a receptor on a B-lymphocyte, a bindingpartner for a B-lymphocyte specific surface antigen, an antibody thatspecifically binds an APC surface molecule and an antibody thatspecifically binds a lymphocyte surface molecule.
 59. The analogueaccording to claim 58, wherein said carbohydrate is mannan, mannose orboth mannan and mannose.
 60. The analogue according to claim 58, whereinsaid APC surface molecule is at least one member selected from the groupconsisting of an FCγ receptor, CD40 and CTLA-4.
 61. The analogueaccording to claim 58, wherein said lymphocyte surface molecule is atleast one member selected from the group consisting of an FCγ receptor,CD40 and CTLA-4.
 62. The analogue according to claim 68, wherein saidsecond molecule is at least one member selected of the group consistingof haptens, cytokines, heat-shock proteins and toxins.
 63. The analogueaccording to claim 62, wherein said cytokine is at least one memberselected from the group consisting of interferon γ, interleukin 1,interleukin 2, interleukin 4, interleukin 6, interleukin 12, interleukin13, interleukin 15 and granulocyte-macrophage colony stimulating factor.64. The analogue according to claim 62, wherein said heat-shock proteinis at least one member selected from the group consisting of HSP70,HSP90 and HSC70.
 65. The analogue according to claim 62, wherein saidtoxin is at least one member selected from the group consisting oflisteriolycin, lipid A and heat-labile enterotoxin.
 66. The analogueaccording to claim 69, wherein said third molecule is at least onemember selected of the group consisting of lipidation anchors, OspA,complement factor C3 and the C3d fragment of complement factor C3. 67.The analogue according to claim 66, wherein said lipidation anchor is atleast one member selected from the group consisting of a myristyl group,a farnesyl group, a geranyl-geranyl group, a GPI-anchor and an N-acyldiglyceride group).
 68. The analogue according to claim 28, wherein saidanalogue is further modified by including a second molecule whichstimulates the immune system.
 69. The analogue according to any one ofclaims 28, 29 and 68, wherein said analogue is further modified byincluding a third molecule which improves presentation of the analogueto the immune system.